Provider Demographics
NPI:1285738864
Name:SAFE HARBOR ANESTHESIA PRACTICE INC
Entity type:Organization
Organization Name:SAFE HARBOR ANESTHESIA PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:727-868-9442
Mailing Address - Street 1:14003 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7124
Mailing Address - Country:US
Mailing Address - Phone:727-868-9442
Mailing Address - Fax:727-862-6210
Practice Address - Street 1:14003 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7124
Practice Address - Country:US
Practice Address - Phone:727-868-9442
Practice Address - Fax:727-862-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ8886OtherRR MEDICARE
FLK2130Medicare PIN