Healthcare Provider Details

I. General information

NPI: 1164651709
Provider Name (Legal Business Name): SEAN C MULCAHY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

3245 SW 34TH ST
OCALA FL
34474-7439
US

V. Phone/Fax

Practice location:
  • Phone: 800-237-6723
  • Fax: 866-665-2702
Mailing address:
  • Phone: 800-237-6723
  • Fax: 866-665-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2001030709
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9289925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: