Basic Information
| Provider Information | |||||||||
| NPI: | 1710944517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAROLINO | ||||||||
| FirstName: | EUGENIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4080 LOCH MEADE DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380029368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013881919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1068 CRESTHAVEN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016826828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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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 | 367500000X | 8790 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 9071 | 01 | TN | OMNI | OTHER | 191848 | 01 | TN | BETTER HEALTH | OTHER | 36832 | 01 | TN | TLC | OTHER | 3605424 | 05 | TN | MEDICAID | 4134153 | 01 | TN | BLUE CROSS | OTHER |