Healthcare Provider Details

I. General information

NPI: 1457313322
Provider Name (Legal Business Name): WESLEY JON BARRETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 SEASON DR
MILTON FL
32570-6440
US

IV. Provider business mailing address

7050 SEASON DR
MILTON FL
32570-6440
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-9515
  • Fax:
Mailing address:
  • Phone: 407-622-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9196687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR841098
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: