Healthcare Provider Details

I. General information

NPI: 1972775906
Provider Name (Legal Business Name): CITRUS ANESTHESIA PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 W GULF TO LAKE HWY
LECANTO FL
34461-9228
US

IV. Provider business mailing address

PO BOX 1300
LECANTO FL
34460-1300
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-4014
  • Fax: 352-326-4126
Mailing address:
  • Phone: 352-634-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEAN T PAULEY
Title or Position: OWNER
Credential: CRNA
Phone: 352-634-2012