Provider Demographics
NPI:1124029087
Name:SAFFORD, HENRY CHARLES (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:CHARLES
Last Name:SAFFORD
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 1:6550 SHORELINE DR
Mailing Address - Street 2:UNIT # 7106
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-4588
Mailing Address - Country:US
Mailing Address - Phone:727-319-0546
Mailing Address - Fax:
Practice Address - Street 1:6550 SHORELINE DR
Practice Address - Street 2:UNIT # 7106
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-4588
Practice Address - Country:US
Practice Address - Phone:727-319-0546
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2022-05-19
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IN28115941A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352143143-46580-01Medicaid
IN000000363412OtherANTHEM PROVIDER ID NUMBER
IL352143143-46580-01Medicaid
INR40117Medicare UPIN
IN08755433Medicare ID - Type UnspecifiedPROVIDER NUMBER