Healthcare Provider Details

I. General information

NPI: 1154491876
Provider Name (Legal Business Name): ELLEN PITCHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

142 STAR SHELL DR
APOLLO BEACH FL
33572-3514
US

V. Phone/Fax

Practice location:
  • Phone: 207-735-7140
  • Fax:
Mailing address:
  • Phone: 207-735-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR023413
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2085072
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2085072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: