Most Relevant Information
Provider Data
| NPI Number: | 1003675992 |
| Provider Name: | CARLY PROVAN CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 367500000X |
| Specialty: | Nurse Anesthetist, Certified Registered |
| License Number: | RN9514153 |
Most Important Dates
| Enumeration Date: | 03/14/2024 |
| Last Updated: | 03/14/2024 |
Provider Practice Location
8000 STATE ROAD 64 E
BRADENTON
FL
342127703
Practice Location Phone/Fax
| Phone: | 9417921404 |
| Fax: |
Provider Mailing Location
12912 USF HEALTH DRIVE
TAMPA
FL
33612
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |