Provider Demographics
NPI:1972577278
Name:HOOTEN, ROGER DEAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DEAN
Last Name:HOOTEN
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:7855 ARGYLE FOREST BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5597
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:1564 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4521
Practice Address - Country:US
Practice Address - Phone:904-264-0400
Practice Address - Fax:904-264-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2019-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN050925367500000X
FLARNP 3307912367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered