Healthcare Provider Details

I. General information

NPI: 1073308482
Provider Name (Legal Business Name): WAWA-VAFON K KWEH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 NEWBERRY RD
GAINESVILLE FL
32607-2247
US

IV. Provider business mailing address

13026 NW 87TH CT
ALACHUA FL
32615-6088
US

V. Phone/Fax

Practice location:
  • Phone: 352-367-2310
  • Fax:
Mailing address:
  • Phone: 352-672-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9522212
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11041974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: