Healthcare Provider Details

I. General information

NPI: 1881954758
Provider Name (Legal Business Name): MICHAEL MUNSON MS, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 KINGSLEY AVE #105
ORANGE PARK FL
32073-4490
US

IV. Provider business mailing address

8358 SW 75TH RD
GAINESVILLE FL
32608-8494
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-7015
  • Fax:
Mailing address:
  • Phone: 352-256-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9169168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: