Provider Demographics
NPI:1992743553
Name:RUTKOWSKI, DOUGLAS JAMES (CRNA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:RUTKOWSKI
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 1:9610 W PARK VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5135
Mailing Address - Country:US
Mailing Address - Phone:813-926-4069
Mailing Address - Fax:
Practice Address - Street 1:9610 W PARK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5135
Practice Address - Country:US
Practice Address - Phone:813-926-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN472962367500000X
FLARNP9230105367500000X
PARN614598367500000X
TXAR108092367500000X
NY522116-01367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered