Healthcare Provider Details

I. General information

NPI: 1568547024
Provider Name (Legal Business Name): MARVIN DALE HILL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 DEL PRADO BLVD S
CAPE CORAL FL
33990-2666
US

IV. Provider business mailing address

PO BOX 22000
SAN ANGELO TX
76902-7200
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-6000
  • Fax:
Mailing address:
  • Phone: 325-658-1511
  • Fax: 325-481-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number529017
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11032475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: