Healthcare Provider Details

I. General information

NPI: 1619945706
Provider Name (Legal Business Name): MICHELE DENISE ALFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BELFORT ROAD
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-4801
  • Fax: 904-265-4811
Mailing address:
  • Phone: 904-483-5850
  • Fax: 904-483-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024185822
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9187227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: