Healthcare Provider Details

I. General information

NPI: 1063499473
Provider Name (Legal Business Name): STEVEN C MIMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7152 COCA SABAL LN GOLF COAST ENDOSCOPY CTR
FT MYERS FL
33908-4263
US

IV. Provider business mailing address

28071 WIRTHROP CR
BONITA SPRINGS FL
34134
US

V. Phone/Fax

Practice location:
  • Phone: 239-985-0215
  • Fax:
Mailing address:
  • Phone: 239-770-8654
  • Fax: 239-992-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3031022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: