Provider Demographics
NPI:1144295908
Name:ROOT, CHRISTOPHER R (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:ROOT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:ROBIN
Other - Last Name:ROOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1315 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3760
Mailing Address - Country:US
Mailing Address - Phone:386-931-2520
Mailing Address - Fax:
Practice Address - Street 1:401 PALMETTO ST
Practice Address - Street 2:BERT FISH MEDICAL CENTER
Practice Address - City:NEW SMYRNA
Practice Address - State:FL
Practice Address - Zip Code:32168-7322
Practice Address - Country:US
Practice Address - Phone:386-424-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2738292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303098900Medicaid
FLG2632XMedicare ID - Type Unspecified
FL303098900Medicaid