Provider Demographics
NPI:1891176202
Name:CAMACHO, DAVID MAURICIO (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MAURICIO
Last Name:CAMACHO
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 1:112 TULPAN DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9559
Mailing Address - Country:US
Mailing Address - Phone:407-908-8220
Mailing Address - Fax:
Practice Address - Street 1:112 TULPAN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-9559
Practice Address - Country:US
Practice Address - Phone:407-908-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9294629367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered