Provider Demographics
NPI:1326085101
Name:KAPSOKAVATHIS, BRIDGET ELENI (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELENI
Last Name:KAPSOKAVATHIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ELENI
Other - Last Name:KOUMANDRAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1268 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3082
Mailing Address - Country:US
Mailing Address - Phone:813-789-1678
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:813-844-4467
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2630332367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437268026OtherMEDICARE PTAN
MI1811044878OtherMEDICARE GROUP NPI
FLG3801OtherFL BCBS PROVIDER #
FL307098100Medicaid
FLG3801OtherFL BCBS PROVIDER #
FLU4877ZMedicare ID - Type UnspecifiedFGTBA MCARE PROVIDER #
FLU4877YMedicare ID - Type UnspecifiedGTB MCARE PROVIDER #