Healthcare Provider Details

I. General information

NPI: 1508918954
Provider Name (Legal Business Name): RYAN JARNES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

132 WIMBERLY WAY
BRISTOL TN
37620-7121
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4478
  • Fax: 904-819-4993
Mailing address:
  • Phone: 407-401-3821
  • Fax: 407-401-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9227816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: