Healthcare Provider Details

I. General information

NPI: 1598028599
Provider Name (Legal Business Name): CHARLIE CROSBY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 352-237-2400
  • Fax: 352-304-6327
Mailing address:
  • Phone: 352-237-2400
  • Fax: 352-304-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9228538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: