Basic Information
| Provider Information | |||||||||
| NPI: | 1003884347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALYNYCH | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 MAJESTIC EAGLE DR | ||||||||
| Address2: | SUNBELT ANESTHESIA SERVICES,LLC | ||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320810611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044122593 | ||||||||
| FaxNumber: | 9046861817 | ||||||||
| Practice Location | |||||||||
| Address1: | 690 MAJESTIC EAGLE DR | ||||||||
| Address2: | SUNBELT ANESTHESIA SERVICES, LLC | ||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320810611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044122593 | ||||||||
| FaxNumber: | 9046861817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2006 | ||||||||
| LastUpdateDate: | 02/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP3014012 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | 3014012 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 3034364-00 | 05 | FL | MEDICAID | 000892009A | 05 | GA | MEDICAID | G20357 | 01 | FL | BLUE CROSS / BLUE SHIELD NUMBER | OTHER |