Individual
NICHOLAS BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
104 FOREST CIR, ORLANDO, FL 32803-6248
(954) 649-6279
Mailing address
104 FOREST CIR, ORLANDO, FL 32803-6248
(954) 649-6279
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9385003
FL
367500000X
Certified Registered Nurse Anesthetist
11019743
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11019743
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B360633910020
DRIVERS LICENSE
FL
Enumeration date
05/05/2020
Last updated
07/13/2022
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