Healthcare Provider Details

I. General information

NPI: 1528790789
Provider Name (Legal Business Name): DAVID GUDISHVILI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 07/17/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

2981 GULF TO BAY BLVD APT 1115
CLEARWATER FL
33759
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone: 360-773-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11027450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: