Provider Demographics
NPI:1194769554
Name:MCOUAT, DOUGLAS CAMERON (CRNA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CAMERON
Last Name:MCOUAT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 NAPA WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3934
Mailing Address - Country:US
Mailing Address - Phone:850-678-4691
Mailing Address - Fax:
Practice Address - Street 1:45 HAMPTON CIRCLE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3257
Practice Address - Country:US
Practice Address - Phone:850-842-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1951942367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305194300Medicaid
FL000G1411Medicare PIN