Healthcare Provider Details

I. General information

NPI: 1326076365
Provider Name (Legal Business Name): THOMAS EDWARD URIBE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DRIVE
HAMPTON VA
23666
US

IV. Provider business mailing address

DEPT 1041 PO BOX 740209
ATLANTA GA
30374-0209
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024080715
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: