Healthcare Provider Details

I. General information

NPI: 1578009429
Provider Name (Legal Business Name): KLAUS NAVAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 W 23RD ST
PANAMA CITY FL
32405-4507
US

IV. Provider business mailing address

2101 W HIGHWAY 390 APT 1101
LYNN HAVEN FL
32444-6510
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9336133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: