Healthcare Provider Details

I. General information

NPI: 1801880042
Provider Name (Legal Business Name): DONALD KRUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 SW 34TH ST
OCALA FL
34474-7439
US

IV. Provider business mailing address

PO BOX 1626
OCALA FL
34478-1626
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-5906
  • Fax: 352-237-8758
Mailing address:
  • Phone: 352-873-0516
  • Fax: 352-873-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2047132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: