Healthcare Provider Details

I. General information

NPI: 1962403964
Provider Name (Legal Business Name): NANCY DALTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

8787 SOUTHSIDE BLVD APT. 3619
JACKSONVILLE FL
32256-3524
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-4667
  • Fax: 904-296-4660
Mailing address:
  • Phone: 904-538-0700
  • Fax: 904-296-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3279092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: