Healthcare Provider Details

I. General information

NPI: 1396722344
Provider Name (Legal Business Name): JOSEPH J MONTANA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/21/2025
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

2006 HOGBACK RD SUITE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8000
  • Fax: 219-852-2515
Mailing address:
  • Phone: 734-263-2414
  • Fax: 517-787-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28164876A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041-287128
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9494266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: