Provider Demographics
NPI:1891365904
Name:TRAVER, JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TRAVER
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 1:2821 46TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4008
Mailing Address - Country:US
Mailing Address - Phone:646-823-4636
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1831
Practice Address - Country:US
Practice Address - Phone:352-273-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2025-01-29
Deactivation Date:2021-06-30
Deactivation Code:
Reactivation Date:2023-01-05
Provider Licenses
StateLicense IDTaxonomies
FL11023719367500000X
FLAPRN11023719367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116876200Medicaid