Provider Demographics
NPI:1023283223
Name:PADGETT, DANIEL DON (CRNA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DON
Last Name:PADGETT
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 1:5049 WINTERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:BASCOM
Mailing Address - State:FL
Mailing Address - Zip Code:32423-9255
Mailing Address - Country:US
Mailing Address - Phone:706-631-3575
Mailing Address - Fax:
Practice Address - Street 1:2224 BRIDGETON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0173
Practice Address - Country:US
Practice Address - Phone:706-631-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176034367500000X
ARC002830367500000X
FLARNP9278003367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001282400Medicaid
FL001282400Medicaid