Healthcare Provider Details

I. General information

NPI: 1578557104
Provider Name (Legal Business Name): NATURE COAST ANESTHESIA PROVIDERS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17560 US HIGHWAY 441
MOUNT DORA FL
32757-6711
US

IV. Provider business mailing address

421 SE ALFRED MARKHAM ST.
LAKE CITY FL
32025
US

V. Phone/Fax

Practice location:
  • Phone: 386-697-1364
  • Fax:
Mailing address:
  • Phone: 386-697-1364
  • Fax: 888-370-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM S JONES
Title or Position: OWNER
Credential: CRNA
Phone: 386-697-1364