Healthcare Provider Details

I. General information

NPI: 1801444807
Provider Name (Legal Business Name): CHRISTOPHER CHROSNIAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

16926 MELISSA ANN DR
LUTZ FL
33558-8049
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-6235
  • Fax:
Mailing address:
  • Phone: 813-454-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9349109
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number091032-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11005404
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number322559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: