Provider Demographics
NPI:1790054849
Name:SWICK, GEORGIA BROWN (CRNA)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:BROWN
Last Name:SWICK
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 1:4501 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4437
Mailing Address - Country:US
Mailing Address - Phone:813-476-5496
Mailing Address - Fax:
Practice Address - Street 1:1556 POLK ST APT 4
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5258
Practice Address - Country:US
Practice Address - Phone:813-476-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9255577367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered