Healthcare Provider Details

I. General information

NPI: 1972725919
Provider Name (Legal Business Name): ALAN-WAYNE JUDE HOWARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 NW 23RD AVE STE 130
GAINESVILLE FL
32606-6541
US

IV. Provider business mailing address

4300 NW 23RD AVE STE 130
GAINESVILLE FL
32606-6541
US

V. Phone/Fax

Practice location:
  • Phone: 386-385-8686
  • Fax:
Mailing address:
  • Phone: 386-385-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3295412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: