Healthcare Provider Details

I. General information

NPI: 1689398729
Provider Name (Legal Business Name): GREATER FLORIDA ANESTHESIOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 HEALTH CENTER DR
LAND O LAKES FL
34637-5837
US

IV. Provider business mailing address

PO BOX 745723
ATLANTA GA
30374-5723
US

V. Phone/Fax

Practice location:
  • Phone: 813-903-3700
  • Fax:
Mailing address:
  • Phone: 197-325-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684