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NPI Code Detail

MEDICARE: MARK AMONETT CRNA

MEDICARE: MARK AMONETT CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist049658TN
2367500000XCertified Registered Nurse AnesthetistAPN0000010560TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23111785OTHERTNBCBS NUMBER

General Provider Information

NPI Number : 1194724757
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK AMONETT CRNA
Provider Business Mailing Address
First Line : 1301 STRATFORD AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37216
Country : US
Telephone Number : 615-226-5047
Fax Number : 615-321-6359
Provider Business Practice Location Address
First Line : 1310 24TH AVE SOUTH
Second Line :
City : NASHVILLE
State : TN
Zip : 37212-2637
Country : US
Telephone Number : 615-327-5390
Fax Number : 615-321-6359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/08/2007

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