Individual
CARLOS DEJESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 824-4990
(904) 824-2226
Mailing address
14359 CHERRY LAKE DR W, JACKSONVILLE, FL 32258-5185
(904) 292-2042
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9175034
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307485400
—
FL
Enumeration date
09/13/2006
Last updated
07/08/2007
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