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General NPI Number Information
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NPI Number | 1215340732
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Entity Type | Individual
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Provider Name | JASON FORTUNA CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 410 N CEDAR BLUFF RD STE 300
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City | KNOXVILLE
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State | TN
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Zip | 37923-3623
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Country | US
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Telephone | 865-342-8900
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Fax | 865-691-0843
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Provider Business Mailing Address
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Address Line | 410 N CEDAR BLUFF RD STE 300
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City | KNOXVILLE
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State | TN
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Zip | 37923-3623
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Country | US
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Telephone | 865-342-8900
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Fax | 865-691-0843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28238845A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 21390
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License Number State | TN
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