Healthcare Provider Details

I. General information

NPI: 1457994063
Provider Name (Legal Business Name): MICHAEL ROBERT DAVITT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4669
US

IV. Provider business mailing address

6435 STONE RIVER RD
BRADENTON FL
34203-7818
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-6611
  • Fax:
Mailing address:
  • Phone: 941-526-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9409550
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number090884-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: