Healthcare Provider Details

I. General information

NPI: 1003645524
Provider Name (Legal Business Name): JAYDA SKYE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

IV. Provider business mailing address

1451 RIDGEWOOD DR
BLACKSHEAR GA
31516-4762
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA287911
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN287911
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: