Healthcare Provider Details

I. General information

NPI: 1508006412
Provider Name (Legal Business Name): MICHAEL JAMES SENECA CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 EAGLE HARBOR PKWY STE B
ORANGE PARK FL
32003-4820
US

IV. Provider business mailing address

11250 OLD SAINT AUGUSTINE RD STE 15 #277
JACKSONVILLE FL
32257-1088
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9180755
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2258055
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number004013
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number798356
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number604947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: