Provider Demographics
NPI:1073267712
Name:SOUTHWEST FLORIDA ANESTHESIA PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA ANESTHESIA PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINC
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:248-762-1538
Mailing Address - Street 1:1237 GREYTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2431
Mailing Address - Country:US
Mailing Address - Phone:248-762-1538
Mailing Address - Fax:
Practice Address - Street 1:1237 GREYTHORNE DR
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2431
Practice Address - Country:US
Practice Address - Phone:248-762-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
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
FLAPRN11015535OtherFLORIDA LICENSE