Provider Demographics
NPI:1730293648
Name:SUMMITT, NANCY VIRGINIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:VIRGINIA
Last Name:SUMMITT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 48TH AVE. S
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:727-698-6046
Mailing Address - Fax:
Practice Address - Street 1:4301 48TH AVE. S
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:727-698-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1885452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered