Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1003852112

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Maitland, Florida. specializing in Certified Registered Nurse Anesthetist. They hold a License No. ARNP3069572 (FL). The NPI Number for Unknown Individual is 1003852112

Main info

Organization

Inactive

25 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1003852112

Phone

(407) 667-0444

Address

291 SOUTHHALL LN

Deactivation Date

6 February 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3217521200

Graduation Year

2001 (25 years ago)

PAC ID

6608773320

Group Practice PAC ID

3577477314

Professional Enrollment ID

I20031218000867

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

291, Southhall Lane, Maitland, Orange County, Florida, 32751, United States
SUITE 201
MAITLAND, FL 327517274
Phone: (407) 667-0444
Fax: (407) 667-4338
Type: Mailing
Rockledge Regional Medical Center, 110, Longwood Avenue, Rockledge, Brevard County, Florida, 32955, United States
ROCKLEDGE, FL 329552828
Phone: (407) 667-0444
Fax: (407) 667-4338
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32751)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3577477314View full group profile

Name	Specialty	State
NATHANIEL MATTHEW BOLLI (M.D.)	A N E S T H E S I O L O G Y	FL
PATRICIA ANN SULLIVAN-LIEBIG (CRNA)	Certified Registered Nurse Anesthetist (Crna)	FL
PETER HAUGHIE	A N E S T H E S I O L O G Y	FL
RICKEY KING (CRNA)	Certified Registered Nurse Anesthetist (Crna)	NY
MRS. HOLLY LYNN RUSSO (C.R.N.A.)	Certified Registered Nurse Anesthetist (Crna)	FL
LUKE WINTER	Certified Registered Nurse Anesthetist (Crna)	FL
JOSEPH HIBBARD (CRNA, ARNP)	Certified Registered Nurse Anesthetist (Crna)	FL
JOSHUA R REYNOLDS (M.D.)	A N E S T H E S I O L O G Y	FL
MRS. BRITTNEY GRACE (CRNA)	Certified Registered Nurse Anesthetist (Crna)	FL
CHARLENE FRANCHI (CRNA)	Certified Registered Nurse Anesthetist (Crna)	PA

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?

Save NPI 1003852112 if you need a stable reference for Unknown Individual.

Is Unknown Individual's inactive status permanent?

An inactive NPI does not by itself prove someone stopped practicing — check other sources.

What field does Unknown Individual work in?

You can think of Unknown Individual as practicing within Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.

Where does public data place Unknown Individual?

The snapshot lists Maitland, Florida for Unknown Individual; download NPPES for the complete set.

What if Maitland, Florida seems incomplete?

Street-level detail can be omitted — open the full address list for this NPI.