Healthcare Provider Details

I. General information

NPI: 1942307491
Provider Name (Legal Business Name): MCCARTY C.R.N.A., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 NW 41ST STREET
GAINESVILLE FL
32606-6630
US

IV. Provider business mailing address

4131 N.W. 13TH STREET SUITE 101
GAINESVILLE FL
32609-1858
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-7733
  • Fax: 352-377-9577
Mailing address:
  • Phone: 352-376-1887
  • Fax: 352-375-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS R. MCCARTY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 352-377-7733