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General NPI Number Information
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NPI Number | 1962578534
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Entity Type | Individual
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Provider Name | ROBERT NATHANIEL LADD CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | NH JACKSONVILLE 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-0001
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Country | US
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Telephone | 904-542-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 9072 REDTAIL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32222-2836
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Country | US
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Telephone | 803-210-7741
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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 | 43256
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License Number State | KY
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