Provider Demographics
NPI:1457639346
Name:BABCOCK, SCOTT LAMAR (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAMAR
Last Name:BABCOCK
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 1:8360 HIGH POINT CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1921
Mailing Address - Country:US
Mailing Address - Phone:813-480-1604
Mailing Address - Fax:
Practice Address - Street 1:15205 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6072
Practice Address - Country:US
Practice Address - Phone:352-597-7744
Practice Address - Fax:352-597-7797
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9198354367500000X, 367500000X
FLAPRN9198354367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered