Healthcare Provider Details

I. General information

NPI: 1457825507
Provider Name (Legal Business Name): JOEL NATHAN FORSYTH MSN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

719 W WEST ST
TAMPA FL
33602-1239
US

V. Phone/Fax

Practice location:
  • Phone: 813-635-5815
  • Fax:
Mailing address:
  • Phone: 240-675-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: