Healthcare Provider Details

I. General information

NPI: 1073589149
Provider Name (Legal Business Name): CHRISTOPHER CRISWELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

5231 PALMETTO WOODS DR
NAPLES FL
34119-2817
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-4862
  • Fax:
Mailing address:
  • Phone: 239-451-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9206172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: