| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CHRISTOPHER ALEXANDER STACZEK | 1205464005 | 2021-06-05 |
Christopher Alexander Staczek is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1205464005. Registration indicates Christopher Alexander Staczek is a provider of services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Anesthetist, Certified Registered (Nurse Anesthetist, Certified Registered, ) (All Other Specialties & Provider Types, ) (Nurse Anesthetist, Certified Registered, Physician Assistants & Advanced Practice Nursing Providers) (Nursing Service Providers, Registered Nurse) (Registered Nurse, ) (All Other Specialties & Provider Types, ) (Registered Nurse, Nursing Service Providers)
| Entity Type | Individual |
| Provider Name | Dr. Christopher Alexander Staczek CRNA |
| Practice Office Address | 520 S LAKE FORMOSA DR ORLANDO, FL US |
| Practice Office Telephone | 4079705620 |
| Mailing Address | 12715 GENEVA GLADE DR RIVERVIEW, FL 335787606 US |
| Business Telephone | 4079705620 |
| Code | Practice | License No State |
|---|---|---|
| 367500000X PRIMARY | Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered Nurse Anesthetist, Certified Registered All Other Specialties & Provider Types Nurse Anesthetist, Certified Registered Physician Assistants & Advanced Practice Nursing Providers | 11013432
FL |
| 163W00000X | Nursing Service Providers Registered Nurse Registered Nurse All Other Specialties & Provider Types Registered Nurse Nursing Service Providers | RN9385383
FL |