Healthcare Provider Details

I. General information

NPI: 1902843782
Provider Name (Legal Business Name): PATRICK ROWAN CROSS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CIRCLE FRONT DR
EVANSVILLE IN
47715-7196
US

IV. Provider business mailing address

2 COLUMBIA DR SUITE A327
TAMPA FL
33606-3508
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4396
  • Fax: 813-844-4972
Mailing address:
  • Phone: 813-844-4396
  • Fax: 813-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28162309A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9188704
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5135A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: