Provider Demographics
NPI:1952303497
Name:WOLFE, JOSEPH W (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:WOLFE
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 1:3825 COUNTRY MILL RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-2235
Mailing Address - Country:US
Mailing Address - Phone:850-637-5999
Mailing Address - Fax:
Practice Address - Street 1:3825 COUNTRY MILL RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-2235
Practice Address - Country:US
Practice Address - Phone:850-637-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9195787367500000X
GARN133186CRNA367500000X
AL1-071770367500000X
NC206034367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59074075OtherBLUE CROSS & BLUE SHIELD
FLG3208OtherBLUE CROSS & BLUE SHIELD
AL59074075OtherBLUE CROSS & BLUE SHIELD