Reference #272465   Priority Posting - CRNA CV - (Individual: CRNA)

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Contact Information [ show unanswered questions ]

CRNA's Name (Preferred Name in parenthesis if desired)
(Tom)
Contact Name
Thomas Fernandez
Contact Email
Contact Street Address 1
8825 Latrec Ave.
Contact Street Address 2
Unit 6-306
Contact City
Orlando
Contact State
Florida
Contact Zip Code
32819-7354
Contact Country
United States
Preferred Contact Method
Email

Position Desired [ show unanswered questions ]

Brief Description of Candidate
21 yrs. Experience with all cases except Open Hearts & Transplant. Prefer Regional (Epidurals Spinals, Peripheral Blocks), OT & Call.
States where clinician wants to work
Arizona
California
Connecticut
Florida
Georgia
Hawaii
Illinois
Indiana
Kansas
Kentucky
Massachusetts
Michigan
Minnesota
Montana
New Jersey
New Mexico
New York
North Carolina
Ohio
Oregon
Pennsylvania
South Carolina
Tennessee
Texas
Virginia
Washington
West Virginia
INTERNATIONAL
Check any Position Durations you would consider:
Locum Tenens
Date Available
06/03/2019
Does CRNA want a Chief CRNA position?
No
Does CRNA want a job that leads to partnership?
No
How often the CRNA wants to do the following:
Chronic Pain Management
Cardiac Anesthesia
Thoracic Anesthesia
Major Vascular Anesthesia
Obstetric Anesthesia
Pediatric Anesthesia
Neuroanesthesia
Trauma Anesthesia
Critical Care Medicine
Anesthesia for outpatient surgery
Office based Anesthesia
Administrative/ Leadership Duties
Regional Anesthesia
Preop Screening Clinic
Orthopedic Anesthesia
Acute Pain Service
Does the CRNA want to be Medically Directed by an Anesthesiologist?
Never
What is the CRNA's preference regarding CRNAs in a job situation doing Operative Cases that are not Medically Directed by an Anesthesiologist?
Negotiable
Does the CRNA want a job where there is an Approved Physician Anesthesia residency program?
No
Does the CRNA want a job where there is Anesthesia training for Physician house staff?
No
Does the CRNA want a job where there is a CRNA training program?
Yes
Does the CRNA want a job where there is an Anesthesiologist's Assistant training program?
No
What practice setting(s) does the CRNA have experience?
Both Academic and Private Practice

Salary and Income Information [ show unanswered questions ]

Employment Status Desired:
Employee (IRS form W-2)
or
Independent Contractor (IRS form 1099).
1099
Does the CRNA want a Salary income from anesthesia group?
No
Does the CRNA want a Percentage income from anesthesia group?
No
Does the CRNA want an Income from Fee-for-service individual practice?
No
Does the CRNA want a Salary from Hospital as an employee?
No
Does the CRNA want Other income as a Hospital employee?
No
How often Does the CRNA want to be on call?
Negotiable
Does the CRNA want to have the Day off after call?
Negotiable

Qualifications [ show unanswered questions ]

States where CRNA is licensed
Arizona
California
Connecticut
Florida
Georgia
Hawaii
Illinois
Indiana
Kansas
Kentucky
Massachusetts
Michigan
Minnesota
Montana
New Jersey
New Mexico
New York
North Carolina
Ohio
Oregon
Pennsylvania
South Carolina
Tennessee
Texas
Virginia
Washington
West Virginia
INTERNATIONAL
CRNA's Degree
CRNA/MS
CRNA's Nurse School
University of Pittsburgh
CRNA's Anesthesia School
University of Pittsburgh
Is CRNA Certified by the NBCRNA?

NBCRNA = National Board on Certification
and Recertification of Nurse Anesthetists
Yes
Year of Primary Certification
1998
Has CRNA completed Subspecialty Extra training
No
Does CRNA have Subspecialty Expertise but has not completed extra training?
No
Check which Life Support cards you currently have:
ACLS
PALS
Is CRNA a New Graduate?

No

Current Employer

Current Employer Name
Self- Employed
Current Employer Address/City/State/Zip
Home Address
CRNA's reason for seeking a job change?
Locum Tenen Employment - Job Ended.

Other

CRNA's Interests
Regional, OT, Call, Autonomy
Name of a reference person
Upon Request
Reference's email
Upon Request
Reference's phone
Upon Request
Comment or paste the text of your CV here, if desired.
Curriculum Vitae

Thomas J. Fernandez, CRNA, MSN
8825 Latrec Avenue; Unit# 6-306
Orlando, Florida 32819-7354
E-mail: tjfernz@gmail.com

CAREER OBJECTIVE:
To obtain a position as a Certified Registered Nurse Anesthetist (CRNA) with a hospital or group practice serving a community, university or university-affiliated hospital with opportunities to practice regional and general anesthesia and possibly engage in teaching.

EDUCATION:
08/95 - 12/97 University of Pittsburgh Nurse Anesthesia’s Office:
School of Nursing; Nurse Anesthesia Program Tele.#: (412) 624-4860
3500 Victoria Street Fax #: (412) 624-1508
360A Victoria Building Email: www.napcrna@pitt.edu
Pittsburgh, Pennsylvania 15261-6360 Student ID# 1236167 (People Soft#)

Masters of Science in Nursing (MSN) - Nurse Anesthesia

Clinical/Hospital Affiliations:
* University of Pittsburgh Medical Center (UPMC) - Presbyterian
and Montifiore Hospitals, and the Eye and Ear Institute.
* Veterans Administration Hospital
* UPMC - Magee Women’s Hospital
* UPMC - Children's Hospital
* Dental Clinic (Dental School at the University of Pittsburgh)
* UPMC - Pain Evaluation and Treatment Institute
* Butler Memorial and UPMC - Citizens General (Community Hospitals)

Regional anesthesia experience included spinal, epidural, axillary, Bier, caudal, popliteal and ankle blocks.

01/94 - 05/95 University of Pittsburgh Registrar’s Office:
School of Nursing Tele.#: (412) 624-7635
3500 Victoria Street Fax #: (412) 624-9782
360A Victoria Building Email: www.registrar.pitt.edu
Pittsburgh, Pennsylvania 15261-6360 Student ID# 1236167 (People Soft#)

Bachelor of Science in Nursing (BSN) Registrar’s Office Address:
University of Pittsburgh
Office of the University Registrar
139 University Place
G3/220 Thackeray Hall Pittsburgh, PA 15260-6820
Pittsburgh, PA 15260-2600

Thomas J. Fernandez, CRNA, MSN Page Two

PROFESSIONAL EXPERIENCE:
02/15 – Pres. King’s Daughter’s Health (Main Hospital) Tele.#: (812) 801-0800
One Bethany Dr./1373 E. State Rd 62 Verification Request: Self-Contracted
P.O. Box 447 (Please call Medical Staff Office)
Madison, IN 47250-0477
(Medical Staff Office) Tele.#: (812) 801-0613
(Medical Staff Office) Fax #: (812) 801-0044
Email: jamesk@kdhmadison.org

10/14 – 01/15 Vacation time off

08/14 – 09/14 Richland Memorial Hospital (Main Hospital) Tele.#: (618) 395-2131
800 East Locust Street Verification Request: Jackson & Coker
Olney, IL 62450-2598 Tel.#: (800) 272-2707
(Medical Staff Office) Tele.#: (618) 395-6085 Direct Tel.#: (678) 690-7220
(Medical Staff Office) Fax #: (618) 393-4215 Fax#: (800) 936-4562
Email: llambi@richlandmemorial.com Email: stmitchell@jacksonandcoker.com

07/14 – 08/14 Penn Highlands Clearfield Hospital (Main Hospital) Tele.#: (814) 765-5341
809 Turnpike Avenue; PO Box 992 Verification Request: Rhino Medical Services
Clearfield, PA 16830-0992 Tel.#: (866) 267-4466
(Medical Staff Office) Tele.#: (814) 768-2180 Fax#: (800) 850-2005
(Medical Staff Office) Fax #: (814) 768-2376 Email: eprovost@rhinomedical.com
Email: dluzier@phhealthcare.org

06/14 – 07/14 Vacation time off

02/14 – 05/14 King’s Daughter’s Health (Main Hospital) Tele.#: (812) 801-0800
One Bethany Dr./1373 E. State Rd 62 Verification Request: Self-Contracted
P.O. Box 447 (Please call Medical Staff Office)
Madison, IN 47250-0477
(Medical Staff Office) Tele.#: (812) 801-0613
(Medical Staff Office) Fax #: (812) 801-0044
Email: jamesk@kdhmadison.org

01/14 – 02/14 Vacation time off

07/13 – 01/14 St. Catherine Hospital (Main Hospital) Tele.#: (620) 272-2222
401 East Spruce Street Verification Request: Lotus Medical Staffing
Garden City, KS 67846-5679 Tel.#: (855) 270-4960
(Medical Staff Office) Tele.#: (620) 272-2226 Direct Tel.#: (469) 277-2522
(Medical Staff Office) Fax #: (620) 272-2114 Fax#: (561) 828-2696
Email: judyirsik@catholichealth.net Email: cjordan@lotusmedstaff.com

06/13 – 07/13 Vacation time off


Thomas J. Fernandez, CRNA, MSN Page Three

PROFESSIONAL EXPERIENCE (continued):
03/13 – 05/13 Bristol Hospital (Main Hospital) Tele.#: (860) 585-3000
41 Brewster Road Verification Request: TIVA Healthcare
Bristol, CT 06010-5161 Tel.#: (800) 506-8482 x1007
(Medical Staff Office) Tele.#: (860) 585-3849 Fax#: (954) 858-0131
(Medical Staff Office) Fax #: (860) 585-3768 Email: Carole.Zaleski@tivahealthcare.com

11/12 – 03/13 Franciscan Physicians Hospital (Main Hospital) Tele.#: (219) 922-4200
701 Superior Avenue Verification Request: Vitruvian Medical
Munster, IN 46321-4038 Tel.#: (713) 227-4600 x207 or 201
(Medical Staff Office) Tele.#: (219) 852-2425 Fax#: (713) 227-4202
(Medical Staff Office) Tele.#: (219) 934-2085 Ext# 6257 (Medical Staff Office) Fax #: (219) 864-2008 Email: wendy@vitruvianmedical.com
(Medical Staff Office) Fax #: (219) 933-2142 Email: pmcdermott@vitruvianmedical.com

09/12 - 11/12 Vacation time off

05/12 – 09/12 Marietta Memorial Health System (Main Hospital) Tele.#: (740) 374-1400
401 Matthew Street Verification Request: Self-Contracted
Marietta, OH 45750-1635 (Please call Medical Staff Office)
(Medical Staff Office) Tele.#: (740) 374-4908
(Medical Staff Office) Fax #: (740) 376-5581

04/10 – 04/12 Riverside Regional Medical Center (Main Hospital) Tele.#: (757) 594-2000
500 J. Clyde Morris Boulevard Verification Request: Alliance Recruiting
Newport News, Virginia 23601-1976 Tel.#: (800) 759-8203 x0 or 1165
(Medical Staff Office) Tele.#: (757) 594-3398 Fax#: (866) 706-4965
(Medical Staff Office) Fax #: (757) 594-2955 Email: bshropshire@alliancerr.com

02/08 – 03/10 *Camden-Clark Medical Center (Main Hospital) Tele.#: (304) 424-4111
St. Joseph’s Campus (Hospital) (Main Hospital) Tele.#: (304) 424-4900
1824 Murdoch Avenue Verification Request: Self-Contracted
Parkersburg, West Virginia 26102-3230 (Please call Medical Staff Office)
(Medical Staff Office) Tele.#: (304) 424-4981
(Medical Staff Office) Fax #: (304) 424-2076

*St. Joseph’s Hospital was acquired by West Virginia United Health System from Signature Hospital Corporation on March 1, 2011. On August 8, 2012, the Camden-Clark Medical Center issued a statement that the St. Joseph’s Campus (Hospital) is set to permanently close. The consolidation process could take 18 months to four years.

11/06 – 01/08 Raleigh General Hospital (Main Hospital) Tele.#: (304) 256-4100
1710 Harper Road Verification Request: TIVA Healthcare
Beckley, West Virginia 25801-3357 Tel.#: (800) 506-8482 x1007
(Medical Staff Office) Tele.#: (304) 256-4076 Fax#: (954) 858-0131
(Medical Staff Office) Fax #: (304) 254-3002 Email: Carole.Zaleski@tivahealthcare.com
Thomas J. Fernandez, CRNA, MSN Page Four

PROFESSIONAL EXPERIENCE (continued):
06/06 – 10/06 Bradford Regional Medical Center (Main Hospital) Tele.#: (814) 368-4143
116 Interstate Parkway; PO Box 0218 Verification Request: J&C Nationwide
Bradford, Pennsylvania 16701-0218 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (814) 362-8327 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (814) 362-8236

02/06 – 05/06 Massena Memorial Hospital (Main Hospital) Tele.#: (315) 769-4200
1 Hospital Drive Verification Request: J&C Nationwide
Massena, New York 13662-1056 Agency is Out-of-Business (Bankrupt) (Medical Staff Office) Tele.#: (315) 769-4335 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (315) 769-4353

10/05 – 01/06 Memorial Medical Center (Main Hospital) Tele.#: (231) 843-2591
1 Atkinson Drive Verification Request: J&C Nationwide
Ludington, Michigan 49431-1906 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (231) 845-2297 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (231) 845-3607

01/05 – 09/05 Uniontown Hospital (Main Hospital) Tele.#: (724) 430-5000
500 West Berkeley Street Verification Request: J&C Nationwide
Uniontown, Pennsylvania 15401-5596 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (724) 430-5742 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (724) 430-5743
https://www.frhscredentials.com/iresponse

11/04 – 01/05 Vacation time off

10/04 – 11/04 Bradford Regional Medical Center (Main Hospital) Tele.#: (814) 368-4143
116 Interstate Parkway; PO Box 0218 Verification Request: J&C Nationwide
Bradford, Pennsylvania 16701-0218 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (814) 362-8327 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (814) 362-8236

11/03 – 10/04 Scotland Memorial Hospital (Main Hospital) Tele.#: (910) 291-7000
500 Lauchwood Drive Verification Request: J&C Nationwide
Laurinburg, North Carolina 28352-5501 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (910) 291-7511 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (910) 291-7419

10/03 - 11/03 Vacation time off

03/00 - 10/03 Brownsville General Hospital (Hospital Is Closed; Out Of Business)
125 Simpson Road
Brownsville, Pennsylvania 15417-9624

Thomas J. Fernandez, CRNA, MSN Page Five

PROFESSIONAL EXPERIENCE (continued):
01/99 - 03/00 Ohio Valley General Hospital (Main Hospital) Tele.#: (412) 777-6161
25 Heckel Road Verification Request: Self-Contracted
McKees Rocks, Pennsylvania 15136-1651 (Please call Medical Staff Office)
(Medical Staff Office) Tele.#: (412) 777-6220
(Medical Staff Office) Fax #: (412) 777-6301

09/98 - 12/98 Davis Memorial Hospital (Main Hospital) Tele.#: (304) 636-3300
812 Gorman Avenue and Reed Street Verification Request: J&C Nationwide
Elkins, West Virginia 26241-3181 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (304) 637-3443 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (304) 637-3441

06/98 - 09/98 Lawrence and Memorial Hospital (Main Hospital) Tele.#: (860) 442-0711
365 Montauk Avenue Verification Request: J&C Nationwide
New London, Connecticut 06320-4700 Agency is Out-of-Business (Bankrupt)
(Medical Staff Office) Tele.#: (860) 442-0711 Ext.#: 3211 (Please call Medical Staff Office)
(Medical Staff Office) Fax #: (860) 444-4723

01/98 - 05/98 Studying for the National Certifying Board Exam - Certified Registered Nurse
Anesthetist and Vacation time off.

CERTIFICATIONS:
01/18 - 01/20 Basic Cardiac Life Support - American Heart Association Status: Active
01/18 - 01/20 Advanced Cardiac Life Support - American Heart Association Status: Active
12/18 - 12/20 Advanced Pediatric Life Support - American Heart Association Status: Active
08/01/18 – 07/31/20 American Association of Nurse Anesthetists No. 49035 Status: Active
Original certification date: April 15, 1998
Verification Contact: Council on Recertification of Nurse Anesthetists
222 North Prospect Avenue; Park Ridge, IL 60068
Tele.#: (847) 692-7050 Fax #: (847) 692-6968 E-mail: (http://www.aana.com)

PROFESSIONAL LICENSURES:
Issued Expire
01/28/13 09/30/19 Arizona Nursing License No. CRNA0910 (ARNP) Status: Active
Tele.#: (602) 771-7800 Online Verification: www.azbn.gov
11/09/98 10/31/20 California Nursing License No. 549602 (RN) Status: Active
11/10/98 10/31/20 California Nursing License No. 2460 (ARNP) Status: Active
Tele.#: (916) 322-3350 Online Verification: www.rn.ca.gov
07/02/98 09/30/19 Connecticut Nursing License No. R55522 (RN) Status: Active
07/02/98 09/30/19 Connecticut Nursing License No. 001862 (ARNP) Status: Active
Tele.#: (860) 509-7624 Online Verification: www.ct.gov/dph/cwp/view.asp?a=3143&q=388910
04/30/99 07/31/20 Florida Nursing License No. RN-3370282 (RN & ARNP) Status: Active
Tele.#: (850) 245-4125 Online Verification: www.doh.state.fl.us/mqa/nursing/index.html
12/21/98 01/31/20 Georgia Nursing License No. RN142400 (RN & ARNP) Status: Active
Tele.#: (478) 207-2440 Online Verification: www.sos.georgia.gov/plb/rn/

Thomas J. Fernandez, CRNA, MSN Page Six

PROFESSIONAL LICENSURES (continued):
Issued Expire
09/10/98 06/30/19 Hawaii Nursing License No. 45970 (RN) Status: Active
10/02/98 06/30/19 Hawaii Nursing License No. 86 (ARNP) Status: Active
Tele.#: (808) 586-3000 Online Verification: www.hawaii.gov/dcca/areas/pvl/boards/nursing
02/09/99 05/31/20 Illinois Nursing License No. 041-313126 (RN) Status: Active
02/26/04 05/31/20 Illinois Nursing License No. 209-005031(ARNP) Status: Active
Tele.#: (312) 8142715 Online Verification: www.idfpr.com/dpr/WHO/nurs.asp
07/20/98 10/31/19 Indiana Nursing License No. 28141688A (RN & ARNP) Status: Active
Tele.#: (317) 234-2043 Online Verification: www.in.gov/pla/nursing.htm
12/21/12 09/30/19 Kansas Nursing License No. 14-121700-091 (RN) Status: Active
12/21/12 09/30/19 Kansas Nursing License No. 43-557138-91 (ARNP) Status: Active
Tele.#: (785) 296-4929 Online Verification: www.ksbn.org
05/06/98 10/31/19 Kentucky Nursing License No. 2702A (ARNP) Status: Active
Tele.#: (502) 429-3300 Online Verification: www.kbn.ky.gov/
12/05/08 09/15/20 Massachusetts Nursing License No. RN2257942 (RN) Status: Active
10/31/12 09/15/20 Massachusetts Nursing License No. RN2257942 (ARNP) Status: Active
Tele.#: (617) 973-0900 or (800) 414-0168
Online Verification: www.mass.gov/eohhs/provider/licensing/occupational/nursing/about/
11/19/98 03/31/21 Michigan Nursing License No. 4704219000 (RN & ARNP) Status: Active
Tele.#: (517) 335-0918 Online Verification:
www.michigan.gov/lara/0.4601.7-154-35299_28150_27529_27542-.00.html
03/31/99 09/30/19 Minnesota Nursing License No. 142848-7 (RN & ARNP) Status: Active
Tele.#: (612) 617-2270 Online Verification: www.nursingboard.state.mn.us/
10/29/98 07/31/19 Missouri Nursing License No. 152374 (ARNP) Status: Active
Tele.#: (573) 751-0681 Online Verification: http://pr.mo.gov/nursing.asp
03/20/13 12/31/20 Montana Nursing License No. 68404 (RN & ARNP) Status: Active
Tele.#: (406) 841-2340
Online Verification: http://bsd.li.mt.gov/license/bsd_boards/nur_board/board_page.asp
03/25/13 05/31/19 New Jersey Nursing License No. 26NR16569300 (RN) Status: Active
11/27/13 05/31/19 New Jersey Nursing License No. 26NJ00477700 (APRN) Status: Active
Tele.#: (973) 504-6430 Online Verification: www.state.nj.us/lps/ca/medical/nursing.htm
11/20/12 09/30/19 New Mexico Nursing License No. CRNA-01235 (ARNP) Status: Active
Tele.#: (505) 841-8340 Online Verification: www.bon.state.nm.us
09/03/91 08/31/21 New York Nursing License No. 434269-1 (RN & ARNP) Status: Active
Tele.#: (518) 474-3817, Ext. 120 Online Verification: www.op.nysed.gov/prof/nurse
07/31/98 07/31/19 North Carolina Nursing License No. 160871 (ARNP) Status: Active
Tele.#: (919) 782-3211 Online Verification: www.ncbon.com
07/01/12 07/31/19 North Carolina CCNA Certification No.49035 (CRNA) Status: Active
09/21/98 08/31/19 Ohio Nursing Lic. No.281366 (RN)/COA# 04692-NA(ARNP) Status: Active
Tele.#: (614) 466-6940 Online Verification: www.nursing.ohio.gov
07/19/13 09/14/19 Oregon Nursing License No. 201390928 (RN) Status: Active
07/19/13 09/14/19 Oregon Nursing License No. 201390929 (ARNP) Status: Active
Tele.#: (971) 673-0685 Online Verification: www.osbn.state.or.us
04/07/94 10/31/20 Pennsylvania Nursing License No. RN336267-L(RN & ARNP)Status: Active
Tele.#: (717) 783-7142 Online Verification:
www.portal.state.pa.us/portal/server.pt/community/state_board_of_nursing/12515

Thomas J. Fernandez, CRNA, MSN Page Seven

PROFESSIONAL LICENSURES (continued):
Issued Expire
12/03/98 04/30/20 South Carolina Nursing License No. 897 (ARNP) Status: Active
Tele.#: (803) 896-4550 Online Verification: www.llr.state.sc.us/pol/nursing
04/07/99 09/30/19 Tennessee Nursing License No. RN-0000123610 (ARNP) Status: Active
Tele.#: (615) 532-5166 OnlineVerification:http://health.state.tn.us/Boards/Nursing/index.htm
12/03/98 09/30/19 Texas Nursing License No. 656531 (RN & ARNP) Status: Active
Tele.#: (512) 305-7400 Online Verification: www.bon.state.tx.us/
04/08/14 12/31/19 US Virgin Islands Nursing License No.AP10559(RN&ARNP) Status: Active
Tele.#: (340) 776-7397 Online Verification: www.vibnl.org
09/17/98 09/30/19 Virginia Nursing License No. 0024161198 (ARNP) Status: Active
Tele.#: (804) 367-4515 Online Verification: www.dhp.virginia.gov/nursing
01/17/13 09/15/19 Washington Nursing License No. RN60322139 (RN) Status: Active
01/17/13 09/15/19 Washington Nursing License No. AP60322142 (ARNP) Status: Active
Tele.#: (360) 236-4700 Online Verification:
www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission.aspx
06/24/98 10/31/19 West Virginia Nursing License No. 55673 (RN) Status: Active
07/01/13 06/30/19 West Virginia Nursing License No. APRN55673-CRNA Status: Active
Tele.#: (304) 558-3596 Online Verification: www.wvrnboard.com

PROFESSIONAL ASSOCIATIONS:
09/01/18 - 08/31/19 American Association of Nurse Anesthetists No. 49035 Status: Active
Reference and Contact Information: (http://www.aana.com)

PROFESSIONAL MALPRACTICE INSURANCE:
American Association of Nurse Anesthetists Insurance Services Status: Active
222 South Prospect Avenue
Park Ridge, Illinois 60068-4035 Phone #: (800) 343-1368 Fax #: (800) 547-2220
CNA (American Casualty) Insurance Company of Reading
Occurrence Policy #: 270759169 Effective Date: 06/24/2018 Expiration Date: 06/24/2019
States: RetroActive Date: 06/24/1998
PA - Present Limits: $200,000 Each Incident / $600,000 Aggregate
IN - Present Limits: $250,000 Each Incident / $750,000 Aggregate AND
Individual Member INPCF.

NATIONAL PROVIDER IDENTIFIER:
Thomas J. Fernandez’s NPI #: 1043211832
Issue/Effective Date: 06/13/2006 Expiration Date: N/A

Reference and Contact Information:
NPI Website https://nppes.cms.hhs.gov or
NPI Enumerator 1-800-465-3203 (NPI Toll-Free)
P.O. Box 6059 1-800-692-2326 (NPI TTY)
Fargo, ND 58108-6059 customerservice@npienumerator.com




Thomas J. Fernandez, CRNA, MSN Page Eight

DRUG ENFORCEMENT ADMINISTRATION (DEA):
Thomas J. Fernandez’s DEA #: MF2840937
Issue/Effective Date: 02/27/2018 Expiration Date: 09/30/2021

Reference and Contact Information:
DEA Website: www.deadiversion.usdoj.gov or

Drug Enforcement Administration
Office of Diversion Control
Attn: Liaison and Policy Section
8701 Morrissette Drive; Springfield, VA 22152

DEA Call Center 1-800-882-9539 (DEA Toll-Free)
• Call your local DEA office. A directory of DEA offices is listed on our website under Offices with Field Registration Technicians.
Directory of DEA offices: http://www.deadiversion.usdoj.gov/drugreg/offices/index.html

CONNECTICUT (CT) CONTROLLED SUBSTANCE REGISTRATION:
Thomas J. Fernandez’s #: CSP0054294
Issue/Effective Date: 03/05/2019 Expiration Date: 02/28/2021

Reference and Contact Information:
CT Drug Control Website: http://www.ct.gov/dcp/site/default.asp
CT Verify a License: https://www.elicense.ct.gov/
• Under “Online Services” box, click on “Lookup a License” then under “License Type” select “Controlled Substance Registration for Practitioner.”

Department of Consumer Protection
165 Capitol Avenue, Hartford, CT 06106
Phone: 860-713-6100 Toll-Free: 800-842-2649 Fax: (860) 713-7239

NEW MEXICO (NM) CONTROLLED SUBSTANCE REGISTRATION:
Thomas J. Fernandez’s #: CS00219863
Issue/Effective Date: 01/16/2014 Expiration Date: 09/30/2019

Reference and Contact Information:
NM Drug Control Website: http://www.rld.state.nm.us/boards/Pharmacy.aspx
NM Verify a License: http://www.rld.state.nm.us/boards/Look_Up_A_License.aspx
• Under “Lookup a License,” click on “Licensed Professional,” fill-in “Search Criteria” for Practitioner.

New Mexico Board of Pharmacy
5200 Oakland NE, Suite A; Albuquerque, NM 87113
Phone: (505) 222-9830 Toll-Free: (800) 565-9102 Fax: (505) 222-9845
Licensing Clerk: (505) 222-9878





Thomas J. Fernandez, CRNA, MSN Page Nine

CONTINUING EDUCATION:
American Association of Nurse Anesthetists 2018 Anesthesia Annual Congress
September 21 - 25, 2018 CE Contact Hours: 14.75/7 (Total Hours: 21.75) Code ID#: 1036177
(The AANA designates this program as meeting the criteria for 7 CE credits in Pharmacology/Therapeutics; California Provider #: 10862; Expiration Date: 09/25/2018)
Boston, MA.

American Association of Nurse Anesthetists 2017 Anesthesia Annual Congress
September 9 - 12, 2017 CE Contact Hours: 19/7.25 (Total Hours: 26.25) Code ID#: 1030986
(The AANA designates this program as meeting the criteria for 7.25 CE credits in Pharmacology/Therapeutics; California Provider #: 10862; Expiration Date: 09/12/2017)
Seattle, WA.

American Association of Nurse Anesthetists 2016 Anesthesia Annual Congress
September 10 - 13, 2016 CE Contact Hours: 20/5 (Total Hours: 25) Code ID#: 1032418
(The AANA designates this program as meeting the criteria for 5 CE credits in Pharmacology/Therapeutics; California Provider #: 10862; Expiration Date: 09/13/2016)
Washington, DC.

REFERENCES:
Available upon request

revised: 03/19

Post Information

Date Posted 03/11/19 07:47pm
Last Updated 03/11/19 07:51pm
Posted By workcrna@gmail.com (Thomas Fernandez)
Reference # 272465
Priority Priority Posting
Section CRNA
Form Type CV
User Type Individual: CRNA
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