William Mark Boudreau, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

ARNP1508292 Issued in FL

Practice address

43309 US Highway 19 N
Tarpon Springs, FL 34689-6221

Phone

(727) 943-3111

Fax

(727) 943-3334

NPI assigned

Jun 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282608000000",
    "number": "1508801853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43309 US HIGHWAY 19 N",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346896221",
            "telephone_number": "727-943-3111",
            "fax_number": "727-943-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43309 US HIGHWAY 19 N",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346896221",
            "telephone_number": "727-943-3111",
            "fax_number": "727-943-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "WILLIAM",
        "middle_name": "MARK",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2010-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP1508292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "G0082",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033916400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Jean Blankenship, LCSW
• Gerard J Bogin, DC
• Christina Bonk
• Deborah Marie Bonnema, COTA
• James Richardson Boone, PH D
• Bowen Research and Training Institute Inc
• Katelyn Bowen
• Maria Bowlin, SFA
• Breaking Free Services LLC
• Breaking Free Services LLC

• Certified Registered Nurse Anesthetist in Tarpon Springs, FL
• Providers in Tarpon Springs, FL by specialty
• Certified Registered Nurse Anesthetist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; 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.