Provider Demographics
NPI:1811977085
Name:GREENWOOD, KEVIN JOSEPH (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:GREENWOOD
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 1:9540 VENTURI DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4645
Mailing Address - Country:US
Mailing Address - Phone:727-460-1767
Mailing Address - Fax:
Practice Address - Street 1:9540 VENTURI DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4645
Practice Address - Country:US
Practice Address - Phone:727-460-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1633502367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0174Medicare ID - Type Unspecified