Healthcare Provider Details

I. General information

NPI: 1255829636
Provider Name (Legal Business Name): KEVIN BLAINE STEWART CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1119
US

IV. Provider business mailing address

900 NW 17TH ST
MIAMI FL
33136-1119
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5512
  • Fax:
Mailing address:
  • Phone: 305-243-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11009837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: