Healthcare Provider Details

I. General information

NPI: 1467429142
Provider Name (Legal Business Name): GAYLE E PERRY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3766 ROSCOMMON DR PMB 190
ORMOND BEACH FL
32174-2849
US

IV. Provider business mailing address

3766 ROSCOMMON DR PMB 190
ORMOND BEACH FL
32174-2849
US

V. Phone/Fax

Practice location:
  • Phone: 407-782-2474
  • Fax:
Mailing address:
  • Phone: 407-782-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3417112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: