KGC CRNA LLC (NPI# 1609215730) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609215730 |
| Entity Type | Organization |
| Organization Name | KGC CRNA LLC |
| Practice Address |
3337 Cappio Dr Melbourne FL 32940-1313 |
| Mailing Address |
Po Box 410580 Melbourne FL 32941-0580 |
| Practice Telephone | 3217594460 |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-07-19 |
| Authorized Official Name | KANDEE GEORGETTE COPPALA (MANAGER/OWNER) |
| Authorized Official Telephone | 3217594460 |
| Authorized Official Credential | CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | ARNP 9217913 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 306690800 | 05 |
| Street Address |
3337 CAPPIO DR |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-1313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356639629 | Brittney Grace | Nurse Anesthetist, Certified Registered | 2136 Dryden Ct, Melbourne, FL 32935-3825 | 2011-07-20 |
| 1417082850 | Jared Saber D'avi | Nurse Anesthetist, Certified Registered | 1040 Inverness Ave, Melbourne, FL 32940-1913 | 2007-02-23 |
| 1164529129 | Salvatore E Bologna | Nurse Anesthetist, Certified Registered | 8040 N Wickham Rd, Melbourne, FL 32940-8298 | 2006-09-20 |
| 1255447223 | Bambi Lynn Durik | Nurse Anesthetist, Certified Registered | 909 E Melbourne Ave, Melbourne, FL 32901-5578 | 2006-08-22 |
| 1073627980 | Patricia Ann Sullivan-liebig | Nurse Anesthetist, Certified Registered | 282 Oak Haven Dr, Melbourne, FL 32940-1810 | 2006-08-18 |
| 1962419820 | Daniel Mcdonough | Nurse Anesthetist, Certified Registered | 1304 Oak St, Melbourne, FL 32901-3111 | 2006-08-02 |
| 1720011877 | Anesthesia Services of Brevard | Nurse Anesthetist, Certified Registered | 315 E Nasa Blvd, Melbourne, FL 32901-1939 | 2006-07-09 |
| 1093747925 | Sandra Jean Bess | Nurse Anesthetist, Certified Registered | 625 Sandpiper Cir, Melbourne, FL 32901-8140 | 2006-07-07 |
| 1427673011 | Jessica Joy Milnor | Nurse Anesthetist, Certified Registered | 1350 Hickory St, Melbourne, FL 32901-3278 | 2020-06-10 |
| 1649745035 | Lovelock Anesthesia LLC | Nurse Anesthetist, Certified Registered | 1700 W Hibiscus Blvd, Melbourne, FL 32901-2615 | 2018-10-11 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.