Healthcare Provider Details

I. General information

NPI: 1811031875
Provider Name (Legal Business Name): GREGORY DAVID SHORT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SW 34TH CIR
OCALA FL
34474-3392
US

IV. Provider business mailing address

500 SE 50TH AVE
OCALA FL
34471-3391
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-2400
  • Fax:
Mailing address:
  • Phone: 352-624-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 2952512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: