Individual
MARTY MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
611 ZEAGLER DR, PALATKA, FL 32177-3810
(386) 326-7865
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP3323342
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002134100
—
FL
01
—
G00CF
BCBS
FL
Enumeration date
06/02/2009
Last updated
02/14/2011
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