Healthcare Provider Details

I. General information

NPI: 1154719037
Provider Name (Legal Business Name): PATRICK SEATON HALKS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

6401 NIKKI LN
TAMPA FL
33625-1641
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8667
  • Fax:
Mailing address:
  • Phone: 352-246-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9296959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: