Healthcare Provider Details

I. General information

NPI: 1710250295
Provider Name (Legal Business Name): ANTONIO MCKAY THOMAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST PALMETTO GENERAL HOSPITAL ANESTHESIOLOGY DEPT.
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

1320 NW 175TH TER
MIAMI FL
33169-4668
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax:
Mailing address:
  • Phone: 305-333-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9163811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: