Provider Demographics
NPI:1871060558
Name:ESPINO, JORGE E (CRNA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:ESPINO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 DORSEY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7027
Mailing Address - Country:US
Mailing Address - Phone:915-449-5800
Mailing Address - Fax:
Practice Address - Street 1:6094 14TH ST W STE 139
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4104
Practice Address - Country:US
Practice Address - Phone:941-360-1566
Practice Address - Fax:941-358-9818
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX787253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered