Healthcare Provider Details

I. General information

NPI: 1982686101
Provider Name (Legal Business Name): RACHEL S FAGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL STOKES

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY WEST FLORIDA MEDICAL CENTER CLINIC PA
PENSACOLA FL
32514
US

IV. Provider business mailing address

8333 N DAVIS HWY MEDICAL CENTER CLINIC ANESTHESIA
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8319
  • Fax: 850-969-2958
Mailing address:
  • Phone: 850-474-8319
  • Fax: 850-969-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3176802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: