Healthcare Provider Details

I. General information

NPI: 1225034473
Provider Name (Legal Business Name): PALSGROVES SWEET DREAMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S HIGHLANDS AVE
SEBRING FL
33870-5418
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-7500
  • Fax:
Mailing address:
  • Phone: 952-442-9771
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1705052
License Number StateFL

VIII. Authorized Official

Name: MICHAEL PALSGROVE
Title or Position: OWNER
Credential: CRNA
Phone: 863-382-7500