Provider Demographics
NPI:1023143500
Name:PITTMAN, KEVIN (CRNA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:CRNA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3601 W COMMERCIAL BLVD SUITE 4
Mailing Address - Street 2:ANESCO NORTH BROWARD LLC
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:1600 SOUTH ANDREWS AVE
Practice Address - Street 2:BROAWRD GENERAL MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9210293367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered