Provider Demographics
NPI:1912329780
Name:ROSE, NELSON MAX (CRNA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:MAX
Last Name:ROSE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 100254
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0254
Mailing Address - Country:US
Mailing Address - Phone:352-273-8610
Mailing Address - Fax:352-273-8612
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5631
Practice Address - Country:US
Practice Address - Phone:352-273-8610
Practice Address - Fax:352-273-8612
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2022-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018225163WR0006X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant