Provider Demographics
NPI:1952740565
Name:GROVES, EMILY J (CRNA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:GROVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:PELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1726 SAFFRON PLUM LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7355
Mailing Address - Country:US
Mailing Address - Phone:304-280-3132
Mailing Address - Fax:
Practice Address - Street 1:110 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2828
Practice Address - Country:US
Practice Address - Phone:321-637-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0094890 00Medicaid
XXX-XX-9958OtherCHAMPUS / TRICARE (SOUTH REGION)
FLG01EGOtherBCBS
XXX-XX-9958OtherCHAMPUS / TRICARE (SOUTH REGION)