Provider Demographics
NPI:1114970555
Name:RUDNICK, RENEE KATHLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KATHLEEN
Last Name:RUDNICK
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:KATHLEEN
Other - Last Name:DOBRASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3231 MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6607
Mailing Address - Country:US
Mailing Address - Phone:813-870-4015
Mailing Address - Fax:813-605-6269
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6607
Practice Address - Country:US
Practice Address - Phone:813-870-4015
Practice Address - Fax:813-605-6269
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9168482367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307731400Medicaid
FL7468805OtherAETNA PIN
FLU7826ZOtherMEDICARE GTBA REASSIGN
FLG4024OtherBCBS
FLP00327774OtherMEDICARE RAILROAD
FLU7826Medicare PIN