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NPI Code Detail

MEDICARE: THERESA MCKEON CRNA

MEDICARE: THERESA MCKEON 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
1367500000XCertified Registered Nurse AnesthetistARNP1871152FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00029833OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2G0260OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1730272048
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA MCKEON CRNA
Provider Business Mailing Address
First Line : PO BOX 862810
Second Line :
City : ORLANDO
State : FL
Zip : 32886-2810
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Provider Business Practice Location Address
First Line : 5013 N ARMENIA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33603-1403
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 07/08/2007

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