Healthcare Provider Details

I. General information

NPI: 1649373549
Provider Name (Legal Business Name): ANTHONY GRAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

13150 NW 50TH AVE
GAINESVILLE FL
32606-3561
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4180
  • Fax: 352-333-4861
Mailing address:
  • Phone: 352-339-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1984732
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1984732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: