Healthcare Provider Details

I. General information

NPI: 1063469849
Provider Name (Legal Business Name): STACY LYNN BAHNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SUNCOAST BLVD SEVEN RIVERS REGIONAL MEDICAL CENTER
CRYSTAL RIVER FL
34428-6712
US

IV. Provider business mailing address

6335 W SETTLER DR
BEVERLY HILLS FL
34465-2083
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-4008
  • Fax:
Mailing address:
  • Phone: 352-527-3889
  • Fax: 352-527-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9173441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: