MEDICARE: CENTRAL FLORIDA ANESTHESIA PROVIDERS LLC

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G900U	OTHER	FL	BC

General Provider Information

NPI Number	:	1912238445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA ANESTHESIA PROVIDERS LLC

Provider Business Mailing Address
First Line	:	1304 SE 46TH ST
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34480-4716
Country	:	US
Telephone Number	:	352-843-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 SE 46TH ST
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34480-4716
Country	:	US
Telephone Number	:	352-843-7490
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	LADDEN D HERRMANN
Credential	:	CRNA
Telephone Number	:	352-216-8639

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	05/08/2017

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