Healthcare Provider Details

I. General information

NPI: 1134150634
Provider Name (Legal Business Name): VITO CANIGLIA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667
US

IV. Provider business mailing address

5424 GRAND BLVD
NEW PORT RICHEY FL
34652
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-5155
  • Fax: 727-849-0759
Mailing address:
  • Phone: 727-845-1736
  • Fax: 727-849-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2783462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: