Provider Demographics
NPI:1063499473
Name:MIMS, STEVEN C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:MIMS
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 1:28071 WIRTHROP CR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134
Mailing Address - Country:US
Mailing Address - Phone:239-770-8654
Mailing Address - Fax:239-992-6905
Practice Address - Street 1:7152 COCA SABAL LN
Practice Address - Street 2:GOLF COAST ENDOSCOPY CTR
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4263
Practice Address - Country:US
Practice Address - Phone:239-985-0215
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3031022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2140Medicare ID - Type Unspecified