Healthcare Provider Details

I. General information

NPI: 1720362999
Provider Name (Legal Business Name): SAMUEL B KNIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH STREET
MIAMI FL
33175
US

IV. Provider business mailing address

1613 N HARRISON PARKWAY #200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-5557
  • Fax: 305-551-2039
Mailing address:
  • Phone: 954-832-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number667490
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9328944
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9328944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: