Healthcare Provider Details

I. General information

NPI: 1083470058
Provider Name (Legal Business Name): ARUN ANTONY JOSEPH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S COLLINS ST
SOUTH ELGIN IL
60177-2454
US

IV. Provider business mailing address

671 WINYAH DR
ORLANDO FL
32803-1226
US

V. Phone/Fax

Practice location:
  • Phone: 224-578-8337
  • Fax:
Mailing address:
  • Phone: 407-303-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1123696
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: