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General NPI Number Information
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NPI Number | 1457994063
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT DAVITT CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 2020 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4669
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Country | US
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Telephone | 941-792-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 6435 STONE RIVER RD
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City | BRADENTON
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State | FL
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Zip | 34203-7818
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Country | US
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Telephone | 941-526-7451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9409550
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 090884-23
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License Number State | NH
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