Healthcare Provider Details

I. General information

NPI: 1336848738
Provider Name (Legal Business Name): ERICA MICHELLE MINTON DNP-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

920 CEDAR DR
BROOKSVILLE FL
34601-2213
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-6111
  • Fax:
Mailing address:
  • Phone: 352-584-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9258227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: