Provider Demographics
NPI:1689620494
Name:TOBIAS, KEVIN L (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:TOBIAS
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 1:3334 PURPLE MARTIN DR
Mailing Address - Street 2:UNIT 124
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-2613
Mailing Address - Country:US
Mailing Address - Phone:941-575-8797
Mailing Address - Fax:
Practice Address - Street 1:4949 TAMIAMI TRL N
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3027
Practice Address - Country:US
Practice Address - Phone:239-261-1158
Practice Address - Fax:239-261-4232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3067772367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3302OtherBC/BS
FLG3302OtherBC/BS