Provider Demographics
NPI:1568456101
Name:NEWMAN, JOHN S (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:NEWMAN
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 1:1329 SW 16TH ST RM 2232
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1128
Mailing Address - Country:US
Mailing Address - Phone:352-733-0485
Mailing Address - Fax:
Practice Address - Street 1:875 STERTHAUS AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5131
Practice Address - Country:US
Practice Address - Phone:386-676-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2860442367500000X
FLAPRN2860442367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1800OtherBLUE SHIELD PROV #
FL302149100Medicaid
FLG1800OtherBLUE SHIELD PROV #
FLG1800WMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER