Healthcare Provider Details

I. General information

NPI: 1124087432
Provider Name (Legal Business Name): PHILLIP A FINK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1180
US

IV. Provider business mailing address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1180
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7974
  • Fax:
Mailing address:
  • Phone: 704-372-7974
  • Fax: 704-372-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5762
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9202145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: