Healthcare Provider Details

I. General information

NPI: 1417955329
Provider Name (Legal Business Name): TATIANA P MCCUEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATIANA FITZWATER AKININA

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 TUSCARORA RD
CARTHAGE NC
28327-8985
US

IV. Provider business mailing address

205 TUSCARORA RD
CARTHAGE NC
28327-8985
US

V. Phone/Fax

Practice location:
  • Phone: 910-322-5787
  • Fax:
Mailing address:
  • Phone: 910-322-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127620
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3243742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: