Provider Demographics
NPI:1336531581
Name:LIGAD, MARK (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LIGAD
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 1:1901 ULMERTON RD.
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:727-573-7777
Mailing Address - Fax:
Practice Address - Street 1:1901 ULMERTON RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-2300
Practice Address - Country:US
Practice Address - Phone:727-573-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9277655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered