Healthcare Provider Details

I. General information

NPI: 1255644514
Provider Name (Legal Business Name): THOMAS ANDREW HUFFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CREEKSIDE BLVD STE 1
NAPLES FL
34108-1931
US

IV. Provider business mailing address

1336 CREEKSIDE BLVD STE 1
NAPLES FL
34108-1931
US

V. Phone/Fax

Practice location:
  • Phone: 918-808-8333
  • Fax:
Mailing address:
  • Phone: 918-808-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number85705
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: