MEDICARE: HENRY ABBOTT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP2699532	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G1678	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1861420614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY ABBOTT CRNA

Provider Business Mailing Address
First Line	:	291 SOUTHHALL LN
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7290
Country	:	US
Telephone Number	:	407-667-0444
Fax Number	:	407-667-4338

Provider Business Practice Location Address
First Line	:	291 SOUTHHALL LN
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7290
Country	:	US
Telephone Number	:	407-667-0444
Fax Number	:	407-667-4338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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