Healthcare Provider Details

I. General information

NPI: 1750757639
Provider Name (Legal Business Name): JOSHUA MICHAEL RIO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322
US

IV. Provider business mailing address

PO BOX 9145
BRADENTON FL
34206-9145
US

V. Phone/Fax

Practice location:
  • Phone: 954-254-1427
  • Fax:
Mailing address:
  • Phone: 941-448-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9328510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: