Provider Demographics
NPI:1962969733
Name:EDDY, YESSENIA ESPEJO (CRNA)
Entity type:Individual
Prefix:
First Name:YESSENIA
Middle Name:ESPEJO
Last Name:EDDY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:YESSENIA
Other - Middle Name:
Other - Last Name:ESPEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1525 W CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1831
Mailing Address - Country:US
Mailing Address - Phone:859-268-1030
Mailing Address - Fax:859-269-4120
Practice Address - Street 1:1525 W CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1831
Practice Address - Country:US
Practice Address - Phone:859-268-1030
Practice Address - Fax:859-269-4120
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010701367500000X
KY3013190367500000X
FL11010701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11010701Medicaid