Provider Demographics
NPI:1972775906
Name:CITRUS ANESTHESIA PROVIDERS LLC
Entity type:Organization
Organization Name:CITRUS ANESTHESIA PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:352-634-2012
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-1300
Mailing Address - Country:US
Mailing Address - Phone:352-634-2012
Mailing Address - Fax:
Practice Address - Street 1:3075 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9228
Practice Address - Country:US
Practice Address - Phone:352-326-4014
Practice Address - Fax:352-326-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2018-09-17
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
FLG9063OtherBLUE SHIELD PROVIDER NUMBER