Provider Demographics
NPI:1164741195
Name:WEIN, AGNIESZKA M (CRNA)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:M
Last Name:WEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:A
Other - Last Name:MULAWA, SUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12926 CASTLEMAINE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4470
Mailing Address - Country:US
Mailing Address - Phone:727-946-0111
Mailing Address - Fax:
Practice Address - Street 1:4809 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1447
Practice Address - Country:US
Practice Address - Phone:813-658-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224296367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP424ZMedicare PIN