Provider Demographics
NPI:1447306527
Name:WELCH, CONNIE M (CRNA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:WELCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0077
Mailing Address - Fax:352-265-6922
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0077
Practice Address - Fax:352-265-6922
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9163659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9163659OtherFL LICENSE
P00242108OtherMEDICARE RAILROAD
FL306242200Medicaid
FLG3450OtherFL BCBS
FLG3450OtherFL BCBS
G3450WMedicare PIN