Healthcare Provider Details

I. General information

NPI: 1801970843
Provider Name (Legal Business Name): JOSEPHINE M MACDONALD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E NASA BLVD
MELBOURNE FL
32901-1939
US

IV. Provider business mailing address

3063 RIO PINO N
INDIALANTIC FL
32903-3732
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-7716
  • Fax: 321-726-0641
Mailing address:
  • Phone: 321-777-5769
  • Fax: 321-777-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1853972
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN1853972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: