Healthcare Provider Details

I. General information

NPI: 1942291174
Provider Name (Legal Business Name): MARTIN JOSEPH CARNEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MADISON ST
NEW PORT RICHEY FL
34652-1971
US

IV. Provider business mailing address

1436 DAVENPORT DR
NEW PORT RICHEY FL
34655-4224
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-8486
  • Fax:
Mailing address:
  • Phone: 727-372-6991
  • Fax: 727-372-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 1831672
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN229116L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: