Healthcare Provider Details

I. General information

NPI: 1659171494
Provider Name (Legal Business Name): MATTHEW CONOR CAVINESS APRN, CRNA, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

450 E LAS OLAS BLVD STE 200E
FORT LAUDERDALE FL
33301-2292
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-5000
  • Fax:
Mailing address:
  • Phone: 888-339-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11038280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: