Basic Information
Provider Information | |||||||||
NPI: | 1598175960 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ARMSTRONG | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 851 TRAFALGAR CT. | ||||||||
Address2: | SUITE 200E | ||||||||
City: | MAITLAND | ||||||||
State: | FL | ||||||||
PostalCode: | 32751 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4076670444 | ||||||||
FaxNumber: | 4076674338 | ||||||||
Practice Location | |||||||||
Address1: | 1350 13TH AVE S | ||||||||
Address2: |   | ||||||||
City: | JACKSONVILLE BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 322503203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9043764182 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2014 | ||||||||
LastUpdateDate: | 07/10/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9294959 | FL | N |   | Nursing Service Providers | Registered Nurse |   | 367500000X | ARNP9294959 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 011913700 | 05 | FL |   | MEDICAID | 003150777A | 05 | GA |   | MEDICAID |