Provider Demographics
NPI:1508193426
Name:TIPPIT, WESLEY ALAN (CRNA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALAN
Last Name:TIPPIT
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 1:901 34TH AVE N.
Mailing Address - Street 2:#7266
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704
Mailing Address - Country:US
Mailing Address - Phone:727-203-5114
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:901 34TH AVE N.
Practice Address - Street 2:#7266
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704
Practice Address - Country:US
Practice Address - Phone:727-203-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9254656367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered