Provider Demographics
NPI:1063408201
Name:MCCABE, PATRICK WILLIAM ED (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM ED
Last Name:MCCABE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 101ST ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1934
Mailing Address - Country:US
Mailing Address - Phone:727-581-5948
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:813-844-4467
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2129302367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3160OtherFL BCBS PROVIDER #
FLG3160OtherFL BCBS PROVIDER #
FLG1435UMedicare ID - Type UnspecifiedGTBA M/CARE PROVIDER #
FLG1435VMedicare ID - Type UnspecifiedFGTBA M/CARE PROVIDER #