Provider Demographics
NPI:1538300819
Name:MIDDLETON, CHARLES E (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:EARL
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4901 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5935
Practice Address - Country:US
Practice Address - Phone:850-477-7042
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183244367500000X
FLAPRN9252142367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002157300Medicaid
GA580628385OtherTRICARE
FLG00C7OtherBLUE CROSS BLUE SHIELD
GA554272OtherWELLCARE
AL593-04904OtherBLUE CROSS BLUE SHIELD
GA988031166CMedicaid
P00857627OtherMEDICARE RAILROAD
GA988031166CMedicaid
GA554272OtherWELLCARE