Individual
CARLY PROVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8000 STATE ROAD 64 E, BRADENTON, FL 34212-7703
(941) 792-1404
Mailing address
12912 USF HEALTH DRIVE, TAMPA, FL 33612
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN9514153
FL
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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