Healthcare Provider Details

I. General information

NPI: 1093003535
Provider Name (Legal Business Name): SERENITY ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BAHIA VISTA ST STE 300
SARASOTA FL
34239-2710
US

IV. Provider business mailing address

PO BOX 6277
SPRINGFIELD IL
62708-6277
US

V. Phone/Fax

Practice location:
  • Phone: 941-373-9808
  • Fax:
Mailing address:
  • Phone: 888-851-4642
  • Fax: 240-342-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LEE SCOTT MITCHEL
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 941-232-4486