Provider Demographics
NPI:1508806183
Name:EARLY, TREY E (CRNA)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:E
Last Name:EARLY
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 1:13330 USF LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6601
Mailing Address - Country:US
Mailing Address - Phone:813-996-6097
Mailing Address - Fax:
Practice Address - Street 1:22524 SHORESIDE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-6614
Practice Address - Country:US
Practice Address - Phone:813-006-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1055329367500000X
FLARNP9275240367500000X
FL9275240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4660OtherBCBS
FLBR977ZMedicare PIN
FLG4660OtherBCBS