Healthcare Provider Details

I. General information

NPI: 1821345398
Provider Name (Legal Business Name): DENICIA MARIA RANKIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 BOYD DR
JACKSON TN
38305-2152
US

IV. Provider business mailing address

88 BOYD DR
JACKSON TN
38305-2152
US

V. Phone/Fax

Practice location:
  • Phone: 228-369-5397
  • Fax:
Mailing address:
  • Phone: 228-369-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN0000172324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: