Healthcare Provider Details

I. General information

NPI: 1164443933
Provider Name (Legal Business Name): THOMAS RENTER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

2209 GREENHILLS DR.
VALRICO FL
33594
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-7335
  • Fax: 813-661-9240
Mailing address:
  • Phone: 813-662-7335
  • Fax: 813-661-9240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2653032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: