Healthcare Provider Details

I. General information

NPI: 1619505203
Provider Name (Legal Business Name): TODD MAGEE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

7556 SW 90TH DR
GAINESVILLE FL
32608-9826
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4000
  • Fax:
Mailing address:
  • Phone: 352-871-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9361859
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11019962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: