Healthcare Provider Details

I. General information

NPI: 1851317648
Provider Name (Legal Business Name): JOSEPH STUART CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6051
  • Fax: 352-379-7489
Mailing address:
  • Phone: 352-374-6051
  • Fax: 352-379-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9321796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: