Provider Demographics
NPI:1679017123
Name:SCANLON, CATHERINE (MSN, CRNA)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 CHARLES BENNETT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1301
Mailing Address - Country:US
Mailing Address - Phone:904-645-7148
Mailing Address - Fax:
Practice Address - Street 1:4635 CHARLES BENNETT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1301
Practice Address - Country:US
Practice Address - Phone:904-571-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9291724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered