Provider Demographics
NPI:1386883783
Name:GREENE, MITSA Y (CRNA)
Entity type:Individual
Prefix:
First Name:MITSA
Middle Name:Y
Last Name:GREENE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MITSA
Other - Middle Name:
Other - Last Name:YOVANOFSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:12925 LITTLETON BEND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7904
Mailing Address - Country:US
Mailing Address - Phone:904-613-1959
Mailing Address - Fax:
Practice Address - Street 1:7051 SOUTHPOINT PKWY S
Practice Address - Street 2:#100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8713
Practice Address - Country:US
Practice Address - Phone:904-854-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3405122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA625003589AMedicaid
GA625003589BMedicaid
FL0007362-00Medicaid
GA625003589BMedicaid
FL0007362-00Medicaid