Healthcare Provider Details

I. General information

NPI: 1942232376
Provider Name (Legal Business Name): GARY WAYNE HUTTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952
US

IV. Provider business mailing address

25431 RANCAGUA DRIVE
PUNTA GORDA FL
33983-4232
US

V. Phone/Fax

Practice location:
  • Phone: 941-629-1181
  • Fax: 941-624-6020
Mailing address:
  • Phone: 941-764-7167
  • Fax: 941-764-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN3330742
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3330742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: