1356468904 NPI number — VERUSCKHA STEPHANIE TORRES TAYAG CRNA

Table of content: VERUSCKHA STEPHANIE TORRES TAYAG CRNA (NPI 1356468904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356468904 NPI number — VERUSCKHA STEPHANIE TORRES TAYAG CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRES TAYAG
Provider First Name:
VERUSCKHA
Provider Middle Name:
STEPHANIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TORRES TAYAG
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356468904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 COLUMBIA DR
Provider Second Line Business Mailing Address:
SUITE A327
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33606-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-844-4396
Provider Business Mailing Address Fax Number:
813-844-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 COLUMBIA DR
Provider Second Line Business Practice Location Address:
SUITE A327
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-844-4396
Provider Business Practice Location Address Fax Number:
813-844-4972
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP9174069 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 308303900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G4254 . This is a "FL BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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