Healthcare Provider Details

I. General information

NPI: 1538156591
Provider Name (Legal Business Name): WENDY ANN WHITFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14547 BRUCE B DOWNS BLVD
TAMPA FL
33613-2709
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-1494
  • Fax: 813-355-5044
Mailing address:
  • Phone: 352-567-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2224182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: