Healthcare Provider Details

I. General information

NPI: 1952839250
Provider Name (Legal Business Name): HALEY JOLENE CAMBRON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S ALAMEDA ST
CORPUS CHRISTI TX
78411
US

IV. Provider business mailing address

333 CAMELLIA DR
CORPUS CHRISTI TX
78404-2403
US

V. Phone/Fax

Practice location:
  • Phone: 361-761-1400
  • Fax:
Mailing address:
  • Phone: 712-898-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberAP133875
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP133875
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: