Provider Demographics
NPI:1003505470
Name:BEACH LIFE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:BEACH LIFE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSEA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CRNA
Authorized Official - Phone:423-368-9518
Mailing Address - Street 1:6449 38TH AVE N STE H4
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1643
Mailing Address - Country:US
Mailing Address - Phone:727-317-2911
Mailing Address - Fax:727-256-0417
Practice Address - Street 1:6449 38TH AVE N STE H4
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1643
Practice Address - Country:US
Practice Address - Phone:727-317-2911
Practice Address - Fax:727-256-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty