Healthcare Provider Details

I. General information

NPI: 1669435780
Provider Name (Legal Business Name): DEAN T PAULEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 W GULF TO LAKE HWY
LECANTO FL
34461-9228
US

IV. Provider business mailing address

5266 S STETSON POINT DR
HOMOSASSA FL
34448-3757
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-0102
  • Fax:
Mailing address:
  • Phone: 352-634-2012
  • Fax: 352-503-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1276032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: