MEDICARE: RENEE KATHLEEN RUDNICK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	9168482	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	U7826Z	OTHER	FL	MEDICARE GTBA REASSIGN
5	P00327774	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7468805	OTHER	FL	AETNA PIN
4	G4024	OTHER	FL	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114970555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE KATHLEEN RUDNICK CRNA

Provider Business Mailing Address
First Line	:	3231 MCMULLEN BOOTH RD
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6607
Country	:	US
Telephone Number	:	813-870-4015
Fax Number	:	813-605-6269

Provider Business Practice Location Address
First Line	:	3231 MCMULLEN BOOTH RD
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6607
Country	:	US
Telephone Number	:	813-870-4015
Fax Number	:	813-605-6269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/14/2025

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