Provider Demographics
NPI:1871599472
Name:MUELLER, MARK STEVENS (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVENS
Last Name:MUELLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-488-2020
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:2601 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4504
Practice Address - Country:US
Practice Address - Phone:941-925-2020
Practice Address - Fax:941-330-2200
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ083949367500000X
AZCRNA0528367500000X
AZRN083949367500000X
FLARNP9277302367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR51492Medicare UPIN
AZZ68118Medicare PIN
AZZ141489Medicare PIN