Healthcare Provider Details

I. General information

NPI: 1720028707
Provider Name (Legal Business Name): ROBERT WEIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

11802 MIDDLEBURY DR
TAMPA FL
33626-2528
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-1255
  • Fax: 813-780-9773
Mailing address:
  • Phone: 813-484-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9162446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: