Healthcare Provider Details

I. General information

NPI: 1194769554
Provider Name (Legal Business Name): DOUGLAS CAMERON MCOUAT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HAMPTON CIRCLE
NICEVILLE FL
32578-3257
US

IV. Provider business mailing address

1032 NAPA WAY
NICEVILLE FL
32578-3934
US

V. Phone/Fax

Practice location:
  • Phone: 850-842-2642
  • Fax:
Mailing address:
  • Phone: 850-678-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1951942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: