Healthcare Provider Details

I. General information

NPI: 1891365904
Provider Name (Legal Business Name): JAMES TRAVER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date: 06/30/2021
Reactivation Date: 01/05/2023

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1831
US

IV. Provider business mailing address

2821 46TH AVE S
SAINT PETERSBURG FL
33712-4008
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone: 646-823-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11023719
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11023719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: