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NPI Code Detail

MEDICARE: MICHAEL WALSH CRNA

MEDICARE: MICHAEL WALSH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistARNP2643722FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00420652OTHERFLMEDICARE RAILROAD

General Provider Information

NPI Number : 1164417960
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WALSH CRNA
Provider Business Mailing Address
First Line : 165 2ND ST W
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33715-1710
Country : US
Telephone Number : 727-867-5722
Fax Number :
Provider Business Practice Location Address
First Line : 900 N ROBERTS AVE
Second Line : DESOTO MEMORIAL HOSPITAL
City : ARCADIA
State : FL
Zip : 34266-8765
Country : US
Telephone Number : 863-494-8475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 11/27/2007

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