Basic Information
| Provider Information | |||||||||
| NPI: | 1528727005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PISCITELLO | ||||||||
| FirstName: | PAIGE | ||||||||
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| Credential: | DNP, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 RIVER COVE CIR | ||||||||
| Address2: | |||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320862901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3863363715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1431 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2021 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11016958 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 11016958 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.