Basic Information
| Provider Information | |||||||||
| NPI: | 1639144157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORNY | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 146 CYPRESS CV | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334588162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615759312 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 TAMPA GENERAL CIR | ||||||||
| Address2: | SUITE A327 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444396 | ||||||||
| FaxNumber: | 8138444972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2006 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP2108512 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 306380100 | 05 | FL | MEDICAID | G3839 | 01 | FL | BCBS | OTHER |