Provider Demographics
NPI:1033267588
Name:RAUCH, ERIK SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:SCOTT
Last Name:RAUCH
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 1:3590 BENSON AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3550
Mailing Address - Country:US
Mailing Address - Phone:727-481-5346
Mailing Address - Fax:727-823-9502
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:727-823-2188
Practice Address - Fax:727-823-9502
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9202839367500000X
FLARNP9202839367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00413034OtherRAILROAD MCR
FL308133800Medicaid
FLG4146OtherBCBS
FL308133800Medicaid