Provider Demographics
NPI:1902046063
Name:ANESTHESIA ASSOCIATES OF WESTERN FLORIDA LLC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF WESTERN FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NUESA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:728-548-6100
Mailing Address - Street 1:6333 54TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1703
Mailing Address - Country:US
Mailing Address - Phone:727-548-6100
Mailing Address - Fax:727-545-0960
Practice Address - Street 1:6333 54TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1703
Practice Address - Country:US
Practice Address - Phone:727-548-6100
Practice Address - Fax:727-545-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102429207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty