Provider Demographics
NPI:1306100466
Name:PRASAD, KRISHNA CHANDRA JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:KRISHNA
Middle Name:CHANDRA
Last Name:PRASAD
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14500 JEKYLL ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-4814
Mailing Address - Country:US
Mailing Address - Phone:239-348-0277
Mailing Address - Fax:
Practice Address - Street 1:1336 CREEKSIDE BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1931
Practice Address - Country:US
Practice Address - Phone:239-261-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90322367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered