Healthcare Provider Details

I. General information

NPI: 1013405026
Provider Name (Legal Business Name): BRITTANI MARIE ROBERTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613
US

IV. Provider business mailing address

10054 ALAFIA PRESERVE AVE APT 104
RIVERVIEW FL
33578-4622
US

V. Phone/Fax

Practice location:
  • Phone: 817-971-6000
  • Fax:
Mailing address:
  • Phone: 404-859-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9417582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9417582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: