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General NPI Number Information
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NPI Number | 1598043572
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Entity Type | Individual
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Provider Name | JACOB D HANTLA CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 1849 W ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85224-9034
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Country | US
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Telephone | 480-241-3769
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Fax | 480-393-4109
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Provider Business Mailing Address
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Address Line | 1849 W ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85224-9034
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Country | US
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Telephone | 480-241-3769
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Fax | 480-393-4109
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN139385
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9307995
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0786
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License Number State | AZ
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