Provider Demographics
NPI:1508006412
Name:SENECA, MICHAEL JAMES (CRNA, MSN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:SENECA
Suffix:
Gender:M
Credentials:CRNA, MSN
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Mailing Address - Street 1:11250 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 15 #277
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 EAGLE HARBOR PKWY STE B
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4820
Practice Address - Country:US
Practice Address - Phone:904-644-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2011-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9180755367500000X
MA2258055367500000X
CT004013367500000X
TX798356367500000X
PA604947367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered