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General NPI Number Information
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NPI Number | 1679087522
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Entity Type | Organization
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Legal Business Name | SAPPHIRE ANESTHESIA LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 4210 67TH AVENUE CIR E
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City | SARASOTA
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State | FL
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Zip | 34243-5101
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Country | US
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Telephone | 410-458-2292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4860
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City | MURRELLS INLET
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State | SC
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Zip | 29576-2698
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Country | US
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Telephone | 843-651-2624
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Fax | 843-491-4023
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Authorized Official
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Title or Position | OWNER
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Name | TARA CAUDIL
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Credential | CRNA
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Telephone | 410-458-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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