Organization
BREVARD ANESTHESIA SERVICES PA
Active
Organization
BREVARD ANESTHESIA SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHENA J SCOTT (ADMINISTRATOR)
(321) 723-4723
Entity
Organization
Contact information
Practice address
1304 OAK ST, MELBOURNE, FL 32901-3111
(321) 723-4723
(321) 727-1448
Mailing address
1304 OAK ST, MELBOURNE, FL 32901-3111
(321) 723-4723
(321) 727-1448
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
FL
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
FL
363L00000X
Nurse Practitioner
—
FL
367500000X
Certified Registered Nurse Anesthetist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00762
BCBSFL
FL
05
—
059707400
—
FL
01
—
K0841
RRMCR
FL
Enumeration date
08/22/2006
Last updated
05/15/2012
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