Healthcare Provider Details

I. General information

NPI: 1336446194
Provider Name (Legal Business Name): JEBB S AINSWORTH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TURKEY LAKE RD
ORLANDO FL
32819-4707
US

IV. Provider business mailing address

15977 JOHNS LAKE OVERLOOK DR
WINTER GARDEN FL
34787-9790
US

V. Phone/Fax

Practice location:
  • Phone: 407-354-5401
  • Fax:
Mailing address:
  • Phone: 251-213-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9245704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: