Healthcare Provider Details

I. General information

NPI: 1306196126
Provider Name (Legal Business Name): JIMMIE RHEA CRAIN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3492 MARTIN HURST RD
TALLAHASSEE FL
32312-1702
US

IV. Provider business mailing address

3200 N SHANNON LAKES DR
TALLAHASSEE FL
32309-2312
US

V. Phone/Fax

Practice location:
  • Phone: 850-701-3920
  • Fax: 850-701-3924
Mailing address:
  • Phone: 850-688-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number6684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: