Provider Demographics
NPI:1134467863
Name:GULFCOAST ANESTHETIST SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:GULFCOAST ANESTHETIST SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LUISETTE
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:941-223-1338
Mailing Address - Street 1:1954 OREGON TRL
Mailing Address - Street 2:#4
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5487
Mailing Address - Country:US
Mailing Address - Phone:941-223-1338
Mailing Address - Fax:941-966-4978
Practice Address - Street 1:1954 OREGON TRL
Practice Address - Street 2:#4
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5487
Practice Address - Country:US
Practice Address - Phone:941-223-1338
Practice Address - Fax:941-966-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-02-26
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
FLE0337UMedicare PIN