Davenport Anesthesia Group LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

DAVENPORT ANESTHESIA GROUP LLC

Practice address

107 Park Place Blvd
Davenport, FL 33837-6858

Phone

(863) 419-2812

Fax

(863) 419-2821

NPI assigned

May 31, 2016

Reactivated

Jul 9, 2021

Last updated

Jul 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nancy K Kastner

Title

Administrator

Phone

(407) 256-0933

Specialties & licenses 1

Addresses

Tax ID family

Adventhealth Surgery Center Davenport2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Davenport Ambulatory Surgery Center, L.L.C.

  • Ambulatory Surgical Clinic/Center
  • Davenport, FL
  • NPI 1912378357
  NPD tax ID

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1457709503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 PARK PLACE BLVD",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376858",
            "telephone_number": "863-419-2812",
            "fax_number": "863-419-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 PARK PLACE BLVD",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376858",
            "telephone_number": "863-419-2812",
            "fax_number": "863-419-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT ANESTHESIA GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "deactivation_date": "2021-06-30",
        "reactivation_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "KASTNER",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-256-0933"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ophelia Dacosta-Green, APRN
• Daniel R. Renuart, MD, PA (Four Corners Pediatrics)
• Dao-Nguyen DMD PA (Zenith Dental)
• Anna A Dao, DMD
• Davenport Ambulatory Surgery Center, L.L.C.
• Davenport Dental Associates LLC
• Davenport Endodontics LLC
• Davenport Medical Center LLC
• Davenport Modern Dentistry, PA (Davenport Modern Dentistry)
• Davenport Opco LLC

• Nursing Care Agency in Davenport, FL
• Providers in Davenport, FL by specialty
• Nursing Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.