Healthcare Provider Details

I. General information

NPI: 1902498934
Provider Name (Legal Business Name): FLOYD FLEMMING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 03/19/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100254
GAINESVILLE FL
32610-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-3441
  • Fax: 352-392-7029
Mailing address:
  • Phone: 352-392-3441
  • Fax: 352-392-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11011549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: