Individual
JACOB D BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 HOSPITAL DR SW, HUNTSVILLE, AL 35801-6455
(256) 429-5074
(256) 429-4674
Mailing address
PO BOX 52404, LAFAYETTE, LA 70505-2404
(256) 429-5071
(256) 429-4674
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9257640
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-136658
ALABAMA CRNA LICENSE
AL
01
—
ARNP9257640
FL LICENSE
FL
Enumeration date
01/19/2012
Last updated
01/17/2013
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