Healthcare Provider Details

I. General information

NPI: 1881005155
Provider Name (Legal Business Name): JENNIFER HODGE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-7000
  • Fax:
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number794366
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number202101925CRNA
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9370984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: