Healthcare Provider Details

I. General information

NPI: 1093011512
Provider Name (Legal Business Name): JOSEPH CAMACHO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAUREL RD E
NORTH VENICE FL
34275-3226
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8720
  • Fax: 941-917-1875
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9237277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: