Individual
ERIC BRIAN EWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
21298 OLEAN BLVD, PORT CHARLOTTE, FL 33952-6705
(941) 629-1181
Mailing address
3415 KNOX TER, PORT CHARLOTTE, FL 33948-2215
(941) 421-4162
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
69110
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9490042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810008119
MEDICAID
WV
01
—
8238851
MEDICARE PTAN
WV
Enumeration date
09/17/2006
Last updated
01/24/2021
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