Provider Demographics
NPI:1154336998
Name:STIGAR, KATHLEEN RAE (CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RAE
Last Name:STIGAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24889 VALDEZ CT
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-6417
Mailing Address - Country:US
Mailing Address - Phone:239-495-9919
Mailing Address - Fax:
Practice Address - Street 1:8901 CONFERENCE DR
Practice Address - Street 2:ST JOHNS SURGERY CENTER
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-481-8833
Practice Address - Fax:239-481-7898
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2069532367500000X
FLCRNA30690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1908Medicare PIN