Provider Demographics
NPI:1457709503
Name:DAVENPORT ANESTHESIA GROUP LLC
Entity Type:Organization
Organization Name:DAVENPORT ANESTHESIA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-256-0933
Mailing Address - Street 1:107 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6858
Mailing Address - Country:US
Mailing Address - Phone:863-419-2812
Mailing Address - Fax:863-419-2821
Practice Address - Street 1:107 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6858
Practice Address - Country:US
Practice Address - Phone:863-419-2812
Practice Address - Fax:863-419-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2021-07-09
Deactivation Date:2021-06-30
Deactivation Code:
Reactivation Date:2021-07-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care