Healthcare Provider Details

I. General information

NPI: 1497463475
Provider Name (Legal Business Name): WILLIAM ANDREW OTT SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 MINA CIR APT 110
FORT MYERS FL
33905-7832
US

IV. Provider business mailing address

5056 MINA CIR APT 110
FORT MYERS FL
33905-7832
US

V. Phone/Fax

Practice location:
  • Phone: 903-736-6425
  • Fax:
Mailing address:
  • Phone: 903-736-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9530578
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number143878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: