Healthcare Provider Details

I. General information

NPI: 1710205679
Provider Name (Legal Business Name): JAIME C GREMILLION CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME TRIPPANY CRNA

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 N KINGS HWY
MYRTLE BEACH SC
29572-3055
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-3381
  • Fax: 843-449-9721
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4211
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: