Healthcare Provider Details

I. General information

NPI: 1124388152
Provider Name (Legal Business Name): JAIMIE L ESTRELLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET DAVOL 129
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

1 VIRGINIA AVE STE 201
PROVIDENCE RI
02905-4444
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4933
  • Fax: 401-444-5090
Mailing address:
  • Phone: 401-490-0916
  • Fax: 401-490-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN00865
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: