Healthcare Provider Details

I. General information

NPI: 1891414249
Provider Name (Legal Business Name): JOHN ELBERT DRIVER III APRN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

8700 FRONT BEACH RD UNIT 1114
PANAMA CITY BEACH FL
32407-4278
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 229-834-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN259465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: