Provider Demographics
NPI:1487622700
Name:BOYD, ADAM MICHAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MICHAEL
Last Name:BOYD
Suffix:
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 1:1187 CEDAR BAY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4938
Mailing Address - Country:US
Mailing Address - Phone:904-509-7096
Mailing Address - Fax:
Practice Address - Street 1:1187 CEDAR BAY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4938
Practice Address - Country:US
Practice Address - Phone:904-509-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3282842363L00000X
FLARNP 3282842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307430700Medicaid
G3905Medicare UPIN
FLG3905ZMedicare PIN
FLG3905Medicare PIN