=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750479903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD NORMAN MCCARTY CRNA,ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 10/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 ROYAL PALM PT
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 2ND AVE
-----------------------------------------------------
City | INDIALANTIC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32903-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-591-2764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 032477
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------