Individual
JESSE CURTIS PENDERGRAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 E 6TH ST, SUITE 205, PANAMA CITY, FL 32401-3661
(850) 785-3185
(850) 785-6233
Mailing address
801 E 6TH ST, SUITE 205, PANAMA CITY, FL 32401-3661
(850) 785-3185
(850) 785-6233
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3299942
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ARNP3299942
FL LICENSE
FL
01
—
G3441
FL BCBS
FL
01
—
P00223639
MEDICARE RAILROAD
—
Enumeration date
01/25/2007
Last updated
07/08/2007
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