Provider Demographics
NPI:1548232390
Name:ESTEP, HOMER D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HOMER
Middle Name:D
Last Name:ESTEP
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 1:2701 MICHELLE CT
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5700
Mailing Address - Country:US
Mailing Address - Phone:850-398-3033
Mailing Address - Fax:
Practice Address - Street 1:2701 MICHELLE CT
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5700
Practice Address - Country:US
Practice Address - Phone:850-398-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1591962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered