Healthcare Provider Details

I. General information

NPI: 1457646721
Provider Name (Legal Business Name): CIMARON EUGENE HOLT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

IV. Provider business mailing address

352 SW TOMMY LITES ST
LAKE CITY FL
32024-0225
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-7200
  • Fax:
Mailing address:
  • Phone: 386-623-1603
  • Fax: 386-752-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9179049
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: