Healthcare Provider Details

I. General information

NPI: 1083150502
Provider Name (Legal Business Name): CHASITY KENTROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 01/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 59TH ST W #4650
BRADENTON FL
34209-4616
US

IV. Provider business mailing address

414 9TH AVE NE
ST PETERSBURG FL
33701-2004
US

V. Phone/Fax

Practice location:
  • Phone: 941-798-3524
  • Fax:
Mailing address:
  • Phone: 941-223-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9278276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: