Healthcare Provider Details

I. General information

NPI: 1942585807
Provider Name (Legal Business Name): CHARLES THOMAS ENDERLE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3309 SW 34TH CIR SUTE 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 NumberARNP3019122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: