Provider Demographics
NPI:1164417960
Name:WALSH, MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALSH
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 1:165 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1710
Mailing Address - Country:US
Mailing Address - Phone:727-867-5722
Mailing Address - Fax:
Practice Address - Street 1:900 N ROBERTS AVE
Practice Address - Street 2:DESOTO MEMORIAL HOSPITAL
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8765
Practice Address - Country:US
Practice Address - Phone:863-494-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2643722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00420652OtherMEDICARE RAILROAD
FLP00420652OtherMEDICARE RAILROAD