1245374610 NPI number — MR. PROMISE G. TOBY CRNA

Table of content: MR. PROMISE G. TOBY CRNA (NPI 1245374610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245374610 NPI number — MR. PROMISE G. TOBY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBY
Provider First Name:
PROMISE
Provider Middle Name:
G.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245374610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2711 SE 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-4724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-732-6189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3309 SW 34TH CIR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-237-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP 9191766 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 592689712 . This is a "6" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 97302 . This is a "4" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N146227 . This is a "1" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 062763100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023855100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com