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Individual

DR. JUSTIN A OTIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DNP, APRN-CRNA

Contact information

Practice address
11723 WELLS CREEK PKWY APT 1217, JACKSONVILLE, FL 32256-1981
(904) 240-2841
Mailing address
2115 JUDGE CARDEN BLVD, CRESTWOOD, KY 40014-7805
(904) 240-2841

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9356204
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
4012118
KY

Other

Enumeration date
07/31/2023
Last updated
01/25/2024
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