Provider Demographics
NPI:1366482622
Name:PRICE, ANITA M (CRNA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 BAYOU GRANDE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1821
Mailing Address - Country:US
Mailing Address - Phone:770-630-3996
Mailing Address - Fax:
Practice Address - Street 1:5905 BAYOU GRANDE BLVD NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1821
Practice Address - Country:US
Practice Address - Phone:770-630-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS41054Medicare UPIN