Healthcare Provider Details

I. General information

NPI: 1073841656
Provider Name (Legal Business Name): GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 STATE ROAD 674
SUN CITY CENTER FL
33573-5256
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4434
  • Fax: 813-844-4972
Mailing address:
  • Phone: 813-844-4396
  • Fax: 813-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CORVINI
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 865-507-7724