Provider Demographics
NPI:1295894384
Name:SEYBOLT, ERIC JAMES (CRNA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:SEYBOLT
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 1:4800 BELFORT ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-483-5850
Mailing Address - Fax:904-483-5860
Practice Address - Street 1:4800 BELFORT ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-265-4801
Practice Address - Fax:904-265-4811
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9171004163W00000X
FLARNP9171004367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL293037400Medicaid
FL293037400Medicaid