Healthcare Provider Details

I. General information

NPI: 1952303497
Provider Name (Legal Business Name): JOSEPH W. WOLFE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 COUNTRY MILL RD
JAY FL
32565-2235
US

IV. Provider business mailing address

3825 COUNTRY MILL RD
JAY FL
32565-2235
US

V. Phone/Fax

Practice location:
  • Phone: 850-637-5999
  • Fax:
Mailing address:
  • Phone: 850-637-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9195787
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN133186CRNA
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-071770
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number206034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: