Healthcare Provider Details

I. General information

NPI: 1992058697
Provider Name (Legal Business Name): ORLANDO ANDRAE ANCHETA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 TUCKER RD
OOLTEWAH TN
37363-8107
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 423-355-7110
  • Fax:
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 Number90836
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: