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General NPI Number Information
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NPI Number | 1659438448
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Entity Type | Individual
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Provider Name | TINA ANN NALLS CRNA, MSNA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 638 CALIFORNIA AVE SW
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City | CAMDEN
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State | AR
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Zip | 71701-4604
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Country | US
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Telephone | 870-836-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 249 DALLAS 262
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City | SPARKMAN
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State | AR
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Zip | 71763-8690
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Country | US
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Telephone | 870-687-3821
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Fax |
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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 | C01505
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License Number State | AR
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