Provider Demographics
NPI:1730717323
Name:KNOTT, VIRGINIA S (CRNA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:S
Last Name:KNOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 SW 84TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8490
Mailing Address - Country:US
Mailing Address - Phone:352-494-9377
Mailing Address - Fax:
Practice Address - Street 1:150 SE 17TH ST STE 503
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5176
Practice Address - Country:US
Practice Address - Phone:352-433-2825
Practice Address - Fax:352-433-2893
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9190222163W00000X
FL11019519367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114419200Medicaid