Healthcare Provider Details

I. General information

NPI: 1316391915
Provider Name (Legal Business Name): TRICHELE D NAZARENO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRICHELE D NUBLA CRNA

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 E MAIN ST SUITE 110
SANTA MARIA CA
93454-4833
US

IV. Provider business mailing address

PO BOX 291264
NASHVILLE TN
37229-1264
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: