Healthcare Provider Details

I. General information

NPI: 1912147638
Provider Name (Legal Business Name): DANIEL JACOB SCHWARTZ C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2009
Last Update Date: 05/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 FIORI DR
CRESTVIEW FL
32539-9522
US

IV. Provider business mailing address

6025 FIORI DR
CRESTVIEW FL
32539-9522
US

V. Phone/Fax

Practice location:
  • Phone: 850-276-0065
  • Fax:
Mailing address:
  • Phone: 850-276-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number56465
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number085330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number748618
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number085330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: