Healthcare Provider Details

I. General information

NPI: 1164657995
Provider Name (Legal Business Name): ANESTHESIA PROFESSIONAL SERVICES OF BREVARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 US HIGHWAY 1
ROCKLEDGE FL
32955-3756
US

IV. Provider business mailing address

PO BOX 16068
HIGH POINT NC
27261-6068
US

V. Phone/Fax

Practice location:
  • Phone: 888-447-7220
  • Fax:
Mailing address:
  • Phone: 336-821-4183
  • Fax: 336-884-1643

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: DR. ANDREW TOBKES
Title or Position: MD
Credential: MD
Phone: 888-447-7220