Provider Demographics
NPI:1801860754
Name:MARKOWSKI, WALTER (CRNA)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:MARKOWSKI
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 1:3300 LOVELAND BLVD
Mailing Address - Street 2:#901
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8789
Mailing Address - Country:US
Mailing Address - Phone:239-939-2622
Mailing Address - Fax:239-939-0151
Practice Address - Street 1:12511 WORLD PLAZA LN BLDG 50
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3991
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2045072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304395900Medicaid
FLG1109OtherBC/BS FL
430005666OtherRAILROAD MEDICARE
FLG1109OtherBC/BS FL
430005666OtherRAILROAD MEDICARE