Healthcare Provider Details

I. General information

NPI: 1477825479
Provider Name (Legal Business Name): DORIS C GOLDEN TEAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S TAMIAMI TRL
SARASOTA FL
34239-4504
US

IV. Provider business mailing address

1360 E VENICE AVE
VENICE FL
34285-9066
US

V. Phone/Fax

Practice location:
  • Phone: 941-925-2020
  • Fax: 941-330-2200
Mailing address:
  • Phone: 941-488-2020
  • Fax: 941-484-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC000988
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9367013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: