Healthcare Provider Details

I. General information

NPI: 1205820347
Provider Name (Legal Business Name): ANTHONY PEVERINI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 STATE ROAD 64 E # 205
BRADENTON FL
34212-7703
US

IV. Provider business mailing address

4362 TRAILS DR
SARASOTA FL
34232-3445
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-0101
  • Fax:
Mailing address:
  • Phone: 941-228-4372
  • Fax: 941-296-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2629992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: