Healthcare Provider Details

I. General information

NPI: 1508247859
Provider Name (Legal Business Name): KALAH JEAN STILWELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KALAH JEAN STILWELL CRNA

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

900 HOPE WAY MANAGED CARE
ALTAMONTE SPRINGS FL
32714-1502
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-0509
  • Fax: 352-237-9808
Mailing address:
  • Phone:
  • Fax: 407-357-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9246865
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024192998
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: