Basic Information
| Provider Information | |||||||||
| NPI: | 1043407612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANQUILITY ANESTHESIA PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20771 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336220771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139776688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15303 AMBERLY DR STE A | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139776688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 09/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | ESCHER | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8139776688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 94864 | 01 | FL | BLUE SHIELD GROUP | OTHER |