MEDICARE: SUNCOAST ANESTHESIOLOGY INC.

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	202D00000X	Integrative Medicine Physician
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1326326323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST ANESTHESIOLOGY INC.

Provider Business Mailing Address
First Line	:	15380 N FLORIDA AVE
Second Line	:	REVIVING MY HEALTH SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33613
Country	:	US
Telephone Number	:	813-898-8980
Fax Number	:	813-898-8981

Provider Business Practice Location Address
First Line	:	11811 N DALE MABRY HWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0917
Country	:	US
Telephone Number	:	813-961-8500
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	DEBRA ERIKSEN D.O.
Credential	:	DO
Telephone Number	:	813-898-8980

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	03/24/2025

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