Healthcare Provider Details

I. General information

NPI: 1891781738
Provider Name (Legal Business Name): CAROL TIFFANY SWEET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3547
US

IV. Provider business mailing address

759 S MAIN ST
WOODSTOCK VA
22664-1127
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-0296
  • Fax: 540-696-0259
Mailing address:
  • Phone: 540-459-1287
  • Fax: 540-459-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024067798
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: