Healthcare Provider Details

I. General information

NPI: 1932487279
Provider Name (Legal Business Name): CHRISTOPHER J BOPP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 DUCK SLOUGH BLVD SUITE 100
TRINITY FL
34655-5073
US

IV. Provider business mailing address

2441 STAVER STREET
PORT CHARLOTTE FL
33980-5914
US

V. Phone/Fax

Practice location:
  • Phone: 727-937-6020
  • Fax: 727-934-1250
Mailing address:
  • Phone: 941-875-9363
  • Fax: 941-875-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9234675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: