Healthcare Provider Details

I. General information

NPI: 1821079054
Provider Name (Legal Business Name): TAMMY LYNN SARAB CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14510 MARSH VIEW DR
JACKSONVILLE FL
32250-2059
US

IV. Provider business mailing address

14510 MARSH VIEW DR
JACKSONVILLE FL
32250-2059
US

V. Phone/Fax

Practice location:
  • Phone: 904-859-8007
  • Fax:
Mailing address:
  • Phone: 904-859-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3339662
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number38199
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: