Healthcare Provider Details

I. General information

NPI: 1457310922
Provider Name (Legal Business Name): MITCHELL J HEATH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 BERRYHILL RD
MILTON FL
32570
US

IV. Provider business mailing address

PO BOX 4152
MILTON FL
32572-4152
US

V. Phone/Fax

Practice location:
  • Phone: 850-626-7762
  • Fax:
Mailing address:
  • Phone: 850-623-8545
  • Fax: 850-623-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP688402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: