Healthcare Provider Details

I. General information

NPI: 1861488595
Provider Name (Legal Business Name): CYNTHIA G ANDERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W FOREST AVE
JACKSON TN
38301-3942
US

IV. Provider business mailing address

410 N CEDAR BLUFF RD STE 300
KNOXVILLE TN
37923-3632
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-1853
  • Fax: 731-664-7731
Mailing address:
  • Phone: 865-342-8900
  • Fax: 865-691-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8706
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: