Organization
KGC CRNA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDEE GEORGETTE COPPALA CRNA (MANAGER/OWNER)
(321) 759-4460
Entity
Organization
Contact information
Practice address
3337 CAPPIO DR, MELBOURNE, FL 32940-1313
(321) 759-4460
Mailing address
PO BOX 410580, MELBOURNE, FL 32941-0580
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP 9217913
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306690800
—
FL
Enumeration date
06/21/2013
Last updated
07/19/2013
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