Provider Demographics
NPI:1568460301
Name:SCOTT, MARDI LYNN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARDI
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:MARDI
Other - Middle Name:LYNN
Other - Last Name:RUSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:SUITE A327
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7677
Mailing Address - Fax:813-844-7677
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-7677
Practice Address - Fax:813-844-7677
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3400272367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3588OtherBCBS
FL306273200Medicaid
FLG3588OtherBCBS