Healthcare Provider Details

I. General information

NPI: 1790369981
Provider Name (Legal Business Name): DOUGLAS ANDREW OEHRLEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SLIGHT BLVD
ORLANDO FL
32806
US

IV. Provider business mailing address

860 N ORANGE AVE APT 210
ORLANDO FL
32801-1043
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-3379
  • Fax:
Mailing address:
  • Phone: 706-587-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN243827
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11026389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: