Healthcare Provider Details

I. General information

NPI: 1578712576
Provider Name (Legal Business Name): DOUGLAS SEAN DIGBY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 ARC WAY
FORT MYERS FL
33966-1352
US

IV. Provider business mailing address

6241 ARC WAY
FORT MYERS FL
33966-1352
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-9955
  • Fax: 239-278-0246
Mailing address:
  • Phone: 239-278-9955
  • Fax: 239-278-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9225726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: