Healthcare Provider Details

I. General information

NPI: 1679546790
Provider Name (Legal Business Name): BRIAN D. MCCOMB CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-2709
US

IV. Provider business mailing address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax:
Mailing address:
  • Phone: 386-231-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9225026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: