MEDICARE: ANITA VICTORIA LEE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP1847722	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295974749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA VICTORIA LEE CRNA

Provider Business Mailing Address
First Line	:	13711 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2417
Country	:	US
Telephone Number	:	813-844-4396
Fax Number	:	813-844-4972

Provider Business Practice Location Address
First Line	:	13711 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2417
Country	:	US
Telephone Number	:	813-844-4396
Fax Number	:	813-844-4972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	06/20/2024

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