Healthcare Provider Details

I. General information

NPI: 1770800872
Provider Name (Legal Business Name): VBLC ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 POINTE WEST BLVD
BRADENTON FL
34209-5531
US

IV. Provider business mailing address

6094 14TH ST W #119
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LYNDA M. COGGINS
Title or Position: MEMBER/MANAGER
Credential: CRNA
Phone: 941-360-1566