Healthcare Provider Details

I. General information

NPI: 1083144836
Provider Name (Legal Business Name): TRICIA LEE HALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD ST
COLUMBUS OH
43228-1607
US

IV. Provider business mailing address

710 TREE BEND CT
WESTERVILLE OH
43082-8924
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-1050
  • Fax:
Mailing address:
  • Phone: 614-581-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: