Healthcare Provider Details

I. General information

NPI: 1316664980
Provider Name (Legal Business Name): NATHANIEL GRAHAM CULROSS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

4850 TAMIAMI TRL N UNIT 301
NAPLES FL
34103-3034
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4000
  • Fax:
Mailing address:
  • Phone: 800-858-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1240002
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11021966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: