Healthcare Provider Details

I. General information

NPI: 1861874091
Provider Name (Legal Business Name): NOVA ANESTHESIA PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 100
ALEXANDRIA VA
22304-1313
US

IV. Provider business mailing address

6094 14TH ST W STE 133
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-5763
  • Fax: 703-370-4655
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN F ANSHER
Title or Position: MEMBER
Credential:
Phone: 941-360-1566