Healthcare Provider Details

I. General information

NPI: 1538170485
Provider Name (Legal Business Name): CLEARWATER ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 HARRIS PKWY SUITE 100
FORT WORTH TX
76132-6103
US

IV. Provider business mailing address

3301 S 14TH ST STE 16180
ABILENE TX
79605-5015
US

V. Phone/Fax

Practice location:
  • Phone: 817-346-3800
  • Fax:
Mailing address:
  • Phone: 325-660-5535
  • Fax: 325-692-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFF T WEERTMAN
Title or Position: MANAGER
Credential: CRNA
Phone: 817-723-9174