Healthcare Provider Details

I. General information

NPI: 1699324236
Provider Name (Legal Business Name): BENJAMIN JAMES CANFIELD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W OAK ST
KISSIMMEE FL
34741-4924
US

IV. Provider business mailing address

3724 MARIETTA WAY
SAINT CLOUD FL
34772-8710
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-2266
  • Fax:
Mailing address:
  • Phone: 208-316-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number966310
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11027325
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number172894
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: