Healthcare Provider Details

I. General information

NPI: 1326505173
Provider Name (Legal Business Name): TANA JAY SHIELDS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 W YUMA MINE CIR
TUCSON AZ
85743-9717
US

IV. Provider business mailing address

5877 W YUMA MINE CIR
TUCSON AZ
85743-9717
US

V. Phone/Fax

Practice location:
  • Phone: 253-905-9657
  • Fax:
Mailing address:
  • Phone: 253-905-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number277707
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN207066
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: