Provider Demographics
NPI:1659305761
Name:BELL, VAN DALE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:DALE
Last Name:BELL
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 1:6698 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5514
Mailing Address - Country:US
Mailing Address - Phone:727-698-3579
Mailing Address - Fax:
Practice Address - Street 1:4703 N ARMENIA AVE
Practice Address - Street 2:ARMENIA SURGERY CENTER
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2618
Practice Address - Country:US
Practice Address - Phone:813-871-9032
Practice Address - Fax:813-873-9543
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1360592367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
62757OtherBCBS
62757OtherBCBS
FLG0116VMedicare PIN