Healthcare Provider Details

I. General information

NPI: 1558890491
Provider Name (Legal Business Name): DANIEL JOAS BELIZAIRE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E ROBINSON ST STE 130
ORLANDO FL
32801-4309
US

IV. Provider business mailing address

P. O. BOX 4918
ORLANDO FL
32802-4918
US

V. Phone/Fax

Practice location:
  • Phone: 407-581-9180
  • Fax: 865-560-7066
Mailing address:
  • Phone: 407-581-9180
  • Fax: 865-560-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9345315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: