Healthcare Provider Details

I. General information

NPI: 1114971090
Provider Name (Legal Business Name): SCOTT LEVELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-0000
  • Fax:
Mailing address:
  • Phone: 813-471-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9218111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: