Healthcare Provider Details

I. General information

NPI: 1831517440
Provider Name (Legal Business Name): GULF COAST PROFESSIONAL ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W BAY DR
LARGO FL
33770-2207
US

IV. Provider business mailing address

PO BOX 3048
SPRINGFIELD IL
62708-3048
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-4642
  • Fax: 240-342-3837
Mailing address:
  • Phone: 240-469-2181
  • Fax: 240-342-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LAURA G ADKINS
Title or Position: EXEC. DIRECTOR OF OPERATIONS
Credential:
Phone: 828-424-0869