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General NPI Number Information
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NPI Number | 1992129365
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Entity Type | Organization
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Legal Business Name | PHYSICIAN PARTNERS OF AMERICA CRNA OPERATIONS LLC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 1717 PRECINCT LINE RD # 100
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City | HURST
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State | TX
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Zip | 76054-3169
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Country | US
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Telephone | 817-369-3995
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Fax | 817-605-9899
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Provider Business Mailing Address
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Address Line | PO BOX 205137
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City | DALLAS
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State | TX
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Zip | 75320-5137
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Country | US
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Telephone | 813-549-2134
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | TRACIE GARI
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Credential |
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Telephone | 813-549-2134
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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