MEDICARE: THAIS RODRIGUEZ FLETCHER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	GAA-CRNA001472	GA
2	367500000X	Certified Registered Nurse Anesthetist	647310	NY

General Provider Information

NPI Number	:	1164978821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAIS RODRIGUEZ FLETCHER CRNA

Provider Business Mailing Address
First Line	:	126 EDUCATION DR
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-9804
Country	:	US
Telephone Number	:	254-319-4654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7324
Country	:	US
Telephone Number	:	254-319-4654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	03/05/2026

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