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General NPI Number Information
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NPI Number | 1770800872
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Entity Type | Organization
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Legal Business Name | VBLC ANESTHESIA LLC
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 6002 POINTE WEST BLVD
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City | BRADENTON
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State | FL
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Zip | 34209-5531
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Country | US
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Telephone | 941-792-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 6094 14TH ST W #119
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City | BRADENTON
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State | FL
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Zip | 34207-4104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | LYNDA M. COGGINS
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Credential | CRNA
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Telephone | 941-360-1566
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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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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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