Healthcare Provider Details

I. General information

NPI: 1730296120
Provider Name (Legal Business Name): RAYMOND JOSEPH CANTWELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

6215 CLAIRDELUNE CT
NEWPORT RICHEY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-8486
  • Fax: 813-979-3064
Mailing address:
  • Phone: 727-457-9259
  • Fax: 727-264-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1675522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: