Provider Demographics
NPI:1558421339
Name:WOLCOTT, JAMES A (CRNA ARNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:CRNA ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 US HIGHWAY 1
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-1611
Mailing Address - Country:US
Mailing Address - Phone:772-388-3344
Mailing Address - Fax:772-388-4002
Practice Address - Street 1:1511 US HIGHWAY 1
Practice Address - Street 2:SUITE 104
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-1611
Practice Address - Country:US
Practice Address - Phone:772-388-3344
Practice Address - Fax:772-388-4002
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203833367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G3602AMedicare ID - Type Unspecified