Healthcare Provider Details

I. General information

NPI: 1932144987
Provider Name (Legal Business Name): BONNIE JEAN KNOX CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 PARISH BLVD
MARY ESTHER FL
32569-1478
US

IV. Provider business mailing address

520 PARISH BLVD
MARY ESTHER FL
32569-1478
US

V. Phone/Fax

Practice location:
  • Phone: 850-499-8093
  • Fax:
Mailing address:
  • Phone: 850-499-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9190858
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number262607
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number575156
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-097300
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR856839
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: