Healthcare Provider Details

I. General information

NPI: 1821067919
Provider Name (Legal Business Name): TAMMY KAY JANSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 S. MCKENZIE DRIVE
FOLEY AL
36535
US

IV. Provider business mailing address

4031 LOCHMOOR DR
PENSACOLA FL
32506-7813
US

V. Phone/Fax

Practice location:
  • Phone: 619-632-8183
  • Fax:
Mailing address:
  • Phone: 619-632-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 638091
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-133734
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9321247
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number01153
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: