Provider Demographics
NPI:1356347595
Name:PALSGROVE, MICHAEL D (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:PALSGROVE
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 1:1497 W AVON BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9511
Mailing Address - Country:US
Mailing Address - Phone:863-453-0419
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:3601 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5418
Practice Address - Country:US
Practice Address - Phone:863-382-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1705052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311532100Medicaid
FLG1981XOtherBX OF FL - NON PAR
FL430071338OtherRAILROAD MEDICARE
FL311532100Medicaid