Provider Demographics
NPI:1730153446
Name:DIGIOVANNI, JOHN R (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DIGIOVANNI
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 1:86 COSEY BEACH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4924
Mailing Address - Country:US
Mailing Address - Phone:203-464-9802
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:SUITE N1
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1806
Practice Address - Country:US
Practice Address - Phone:860-525-1900
Practice Address - Fax:860-522-9913
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9228977367500000X
CTE55174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306952400Medicaid
CT1730153446Medicare PIN
FL306952400Medicaid