Healthcare Provider Details

I. General information

NPI: 1720039746
Provider Name (Legal Business Name): GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR SUITE A327
TAMPA FL
33606-3571
US

IV. Provider business mailing address

400 N ASHLEY DR SUITE 1625
TAMPA FL
33602-4300
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4434
  • Fax: 813-844-4972
Mailing address:
  • Phone: 813-514-6387
  • Fax: 813-229-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CORVINI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-507-7724