Healthcare Provider Details

I. General information

NPI: 1144295908
Provider Name (Legal Business Name): CHRISTOPHER R. ROOT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS ROBIN ROOT

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PALMETTO ST BERT FISH MEDICAL CENTER
NEW SMYRNA FL
32168-7322
US

IV. Provider business mailing address

1315 S CENTRAL AVE
FLAGLER BEACH FL
32136-3760
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-5025
  • Fax:
Mailing address:
  • Phone: 386-931-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2738292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: