Healthcare Provider Details

I. General information

NPI: 1710324546
Provider Name (Legal Business Name): BESSY WILSON BENJAMIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIRCLE, SUITE A327 FLORIDA GULF TO BAY ANESTHESIOLOGY ASSOCIATES, LLC
TAMPA FL
33606
US

IV. Provider business mailing address

470 8TH ST SE
NAPLES FL
34117-9351
US

V. Phone/Fax

Practice location:
  • Phone: 954-812-4250
  • Fax:
Mailing address:
  • Phone: 954-812-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9265820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: