Provider Demographics
NPI:1962419390
Name:CUNNINGHAM, JOHN THOMAS (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:CUNNINGHAM
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:PO BOX 742318
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2318
Mailing Address - Country:US
Mailing Address - Phone:352-867-8898
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:C/O SEVEN RIVERS REGIONAL
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:352-795-4008
Practice Address - Fax:352-795-9041
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP881782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301877600Medicaid
R27983Medicare UPIN
FL301877600Medicaid