MEDICARE: KENDALL PETER DRIESSE C.R.N.A.

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	ARNP1427812	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G2003	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1861476673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL PETER DRIESSE C.R.N.A.

Provider Business Mailing Address
First Line	:	18123 REGENTS SQUARE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2291
Country	:	US
Telephone Number	:	813-919-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COLUMBIA DR
Second Line	:	SUITE A327
City	:	TAMPA
State	:	FL
Zip	:	33606-3508
Country	:	US
Telephone Number	:	813-844-4434
Fax Number	:	813-844-4467

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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