Healthcare Provider Details

I. General information

NPI: 1689652083
Provider Name (Legal Business Name): KENNETH ANDREW BAILEY JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 TAMIAMI TRAIL
SARASOTA FL
34239
US

IV. Provider business mailing address

5849 SOUTH MIAMI ROAD
VENICE FL
34293
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-3480
  • Fax:
Mailing address:
  • Phone: 941-493-5892
  • Fax: 941-496-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1411712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: