Healthcare Provider Details

I. General information

NPI: 1992041883
Provider Name (Legal Business Name): TINA N. ASHLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA J. POWERS CRNA

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WATSON BLVD
WARNER ROBINS GA
31093-3431
US

IV. Provider business mailing address

PO BOX 235019
MONTGOMERY AL
36123-5019
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-1450
  • Fax: 334-395-4110
Mailing address:
  • Phone: 334-279-1450
  • Fax: 334-395-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN119740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: