Provider Demographics
NPI:1861519340
Name:POLLEY, ROBERT DONALD JR (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DONALD
Last Name:POLLEY
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 STAVELEY DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5259
Mailing Address - Country:US
Mailing Address - Phone:951-816-0982
Mailing Address - Fax:
Practice Address - Street 1:ENVISION PHYSCIANS SERVICES
Practice Address - Street 2:1301 RIVERSIDE BLVD, SUITE 2540
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-603-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582041367500000X
FLAPRN9439834367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered