Healthcare Provider Details

I. General information

NPI: 1427359645
Provider Name (Legal Business Name): DOUGLAS S. MCMILLAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SW 34TH CIR SUITE 101
OCALA FL
34474-3392
US

IV. Provider business mailing address

PO BOX 848558
BOSTON MA
02284-8558
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-0509
  • Fax: 352-237-9808
Mailing address:
  • Phone: 352-237-0509
  • Fax: 352-237-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9323545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: