Healthcare Provider Details

I. General information

NPI: 1689620494
Provider Name (Legal Business Name): KEVIN L. TOBIAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 TAMIAMI TRL N SUITE 206
NAPLES FL
34103-3027
US

IV. Provider business mailing address

3334 PURPLE MARTIN DR UNIT 124
PUNTA GORDA FL
33950-2613
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-1158
  • Fax: 239-261-4232
Mailing address:
  • Phone: 941-575-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 3067772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: