SOUTH LAKE ANESTHESIA SERVICES, P.A. (NPI# 1346255056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346255056 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE ANESTHESIA SERVICES, P.A. |
| Practice Address |
1900 Don Wickham Dr Clermont FL 34711-1979 |
| Mailing Address |
Po Box 100024 Atlanta GA 30348-0024 |
| Practice Telephone | 3522439114 |
| Practice Fax Number | 3522437822 |
| Mailing Telephone | 3522439114 |
| Mailing Fax Number | 3522437822 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2011-12-09 |
| Authorized Official Name | DR. DAVID S GHIVIZZANI (OWNER) |
| Authorized Official Telephone | 3522439114 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
FL | Allopathic & Osteopathic Physicians | |
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 259314900 | 05 | |
| FL | RAILROAD MEDICARE | DA3883 | 01 |
| FL | BLUE CROSS BLUE SHIELD | 45233 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750710778 | South Lake Anesthesia Services, P.a. | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2013-11-12 |
| Street Address |
1900 DON WICKHAM DR |
| City | CLERMONT |
| State | FL |
| Zip Code | 34711-1979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932107133 | Nulma B Carguill | Physician Assistant | 1900 Don Wickham Dr, Mp Sl Admin, Clermont, FL 34711-1979 | 2005-07-12 |
| 1780296269 | Megan Beck | Nurse Practitioner | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2020-08-17 |
| 1861034506 | Jo'el Bartley | Registered Nurse | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2019-10-15 |
| 1356998611 | Heather Lynnette Chandler | Nurse Practitioner | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2019-08-21 |
| 1942780481 | Aurora Queckboerner | Registered Nurse | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2018-08-15 |
| 1114420189 | Dawn M Taylor | Nurse Practitioner | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2018-03-15 |
| 1184134728 | Orange Anesthesia Associates, Inc. | Anesthesiology | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2017-10-10 |
| 1295244176 | Michelle Isaacs | Registered Nurse | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2017-09-24 |
| 1568990315 | Devadah La Jeune King | Nurse Practitioner | 1900 Don Wickham Dr, Clermont, FL 34711 | 2017-05-24 |
| 1659808285 | Ines Alejandra Serrano Vilca | Family Medicine | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2017-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316546344 | Latricia Richards-smith | Nurse Practitioner | 3301 Hancock Rd, Clermont, FL 34711 | 2020-10-21 |
| 1073130399 | Marissa Johnston | Behavioral Analyst | 355 Citrus Tower Blvd Ste 112, Clermont, FL 34711 | 2020-07-02 |
| 1649839432 | New Foundations Aba Therapy, LLC | Community/Behavioral Health | 4327 S Hwy 27 #176 Clermont, Clermont, FL 34711 | 2019-06-06 |
| 1275006504 | Innovative Medical Management Solutions LLC | Skilled Nursing Facility | 1775 Hooks Street, Clermont, FL 34711 | 2019-01-09 |
| 1851867766 | Chantal P Baptiste | Nurse Practitioner | 2040 Oakley Seaver Dr Ste 300, Clermont, FL 34711 | 2018-10-17 |
| 1346739539 | Jennifer Brennan | Behavior Technician | 365 Citrus Tower Blvd Bldg Ste 106, Clermont, FL 34711 | 2018-05-03 |
| 1689163966 | Chelsea Strickland | Physical Therapy Assistant | 10037 Stockbridge St, Clermont, FL 34711 | 2018-05-02 |
| 1316448921 | Dana Renee Ottalagano | Counselor | 1635 E Highway 50 Ste 204, Clermont, FL 34711 | 2018-02-28 |
| 1306353842 | Center of Change Inc. | General Practice | 235 Citrus Tower Blvd Ste 104, Clermont, FL 34711 | 2018-01-05 |
| 1003328642 | Clermont Radiology LLC | Clinic/Center | 3725 South Highway 27, Suite 104, Clermont, FL 34711 | 2017-11-03 |
| Find all providers in zip 34711 | ||||
| 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 |
|---|---|---|---|---|
| 1750710778 | South Lake Anesthesia Services, P.a. | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2013-11-12 |
| 1902180912 | Dawn Lieberman | Nurse Anesthetist, Certified Registered | 1900 Don Wickham Dr, Clermont, FL 34711 | 2011-10-10 |
| 1982761615 | Dan E Nesmith | Nurse Anesthetist, Certified Registered | 1381 Citrus Tower Blvd, Suite 4, Clermont, FL 34711-1957 | 2007-01-02 |
| 1396845608 | Laurie Parker | Nurse Anesthetist, Certified Registered | 1381 Citrus Tower Blvd, Suite 4, Clermont, FL 34711 | 2006-09-25 |
| 1457451726 | Timo Chacon | Nurse Anesthetist, Certified Registered | 1381 Citrus Tower Blvd, Suite 4, Clermont, FL 34711-1957 | 2006-09-25 |
| 1780787689 | Richard Thomas Lee | Nurse Anesthetist, Certified Registered | 1381 Citrus Tower Blvd, Suite 4, Clermont, FL 34711 | 2006-09-06 |
| 1144338666 | Marvin Christopher Aldabute | Nurse Anesthetist, Certified Registered | 1900 Don Wickham Dr, Clermont, FL 34711-1979 | 2006-08-25 |
| 1407875396 | David Vernon Hidalgo | Nurse Anesthetist, Certified Registered | 1381 Citrus Tower Blvd, Suite 4, Clermont, FL 34711 | 2006-07-19 |
| 1548293947 | Teresa Layman | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-07-09 |
| 1780616599 | Imke Casey | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-07-06 |
| Find all providers in CLERMONT | ||||
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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.