Basic Information
| Provider Information | |||||||||
| NPI: | 1962419390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742318 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528678898 | ||||||||
| FaxNumber: | 8666652702 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 N SUNCOAST BLVD | ||||||||
| Address2: | C/O SEVEN RIVERS REGIONAL | ||||||||
| City: | CRYSTAL RIVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527954008 | ||||||||
| FaxNumber: | 3527959041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP881782 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 301877600 | 05 | FL | MEDICAID |