Individual provider Active NPI

Debra Wahlstrom, CRNA

  • Certified Registered Nurse Anesthetist
  • Tampa, FL
National Provider Identifier
1417134594
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9178022 Issued in FL
Practice address
4519 George Rd
Ste 100
Tampa, FL 33634-7329
Phone
(813) 496-1075
NPI assigned
Jan 30, 2008
Last updated
Jan 30, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X ARNP9178022 FL Primary

Addresses

Primary practice location

4519 George Rd
Ste 100
Tampa, FL 33634-7329

Mailing address

4519 George Rd
Ste 100
Tampa, FL 33634-7329
Phone (813) 496-1075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080430000213 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8426137696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

119 Oakfield Dr
Brandon, FL 33511-5779
Phone (954) 939-5000

900 Carillon Pkwy
Suite 205
Saint Petersburg, FL 33716-1108
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Florida Anesthesiologists, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2011 Accepting new patients
Greater Florida Anesthesiologists, LLC Current Accepting new patients
Greater Florida Anesthesiologists, LLC CurrentSince Jan 1, 2011 Accepting new patients
North Tampa Anesthesia Consultants Past Accepting new patients

Locations

119 Oakfield Dr
Brandon, FL 33511
Phone (813) 571-5150

300 Pinellas St
Clearwater, FL 33756
Phone (727) 461-8552

2140 W 68th St
Hialeah, FL 33016
Phone (305) 332-2065

460 N State Road 7
Royal Palm Beach, FL 33411
Phone (561) 792-7333

900 Carillon Pkwy
Ste 205
St Petersburg, FL 33716
Phone (727) 561-2710

2600 Bruce B Downs Blvd
Zephyrhills, FL 33544
Phone (954) 393-5000

Networks

  • Optimum HealthCare HMO Network

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201651200000",
    "number": "1417134594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4519 GEORGE RD",
            "address_2": "STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347329",
            "telephone_number": "813-496-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4519 GEORGE RD",
            "address_2": "STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347329",
            "telephone_number": "813-496-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "DEBRA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9178022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.