Healthcare Provider Details

I. General information

NPI: 1285614560
Provider Name (Legal Business Name): STEVEN EDWARD WILDASIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL JACKSONVILLE 2080 CHILD STREET
JACKSONVILLE FL
32214-0001
US

IV. Provider business mailing address

286 RIDGELINE CT
ORANGE PARK FL
32065-5715
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7631
  • Fax: 904-542-7623
Mailing address:
  • Phone: 904-272-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9223320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: