Provider Demographics
NPI:1124087432
Name:FINK, PHILLIP A (CRNA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:FINK
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 1:300 BILLINGSLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1180
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-372-7974
Practice Address - Street 1:300 BILLINGSLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1180
Practice Address - Country:US
Practice Address - Phone:704-372-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5762367500000X
FLARNP9202145367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ58835EOtherPTAN
FLG3362BMedicare ID - Type UnspecifiedFOR ANESCO ANES. ASSOC.