Healthcare Provider Details

I. General information

NPI: 1457740185
Provider Name (Legal Business Name): AMY DIANE CALCOTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY DIANE GULLEY

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

2673 FOX CREEK DR E
JACKSONVILLE FL
32221-2895
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-0411
  • Fax:
Mailing address:
  • Phone: 904-507-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9288726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: