Provider Demographics
NPI:1578654885
Name:SWAN, STEPHEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SWAN
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 1:4213 W SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7701
Mailing Address - Country:US
Mailing Address - Phone:813-340-4224
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR STE A327
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3683
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3626061Medicare ID - Type Unspecified