1033488432 NPI number — JASON TRENT CROSSLIN CRNA

Table of content: JASON TRENT CROSSLIN CRNA (NPI 1033488432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033488432 NPI number — JASON TRENT CROSSLIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSSLIN
Provider First Name:
JASON
Provider Middle Name:
TRENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033488432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 PLAYERS CLUB PKWY
Provider Second Line Business Mailing Address:
STE 350
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-8949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-844-1590
Provider Business Mailing Address Fax Number:
901-844-1592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 SAUNDERSVILLE RD
Provider Second Line Business Practice Location Address:
160
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-824-3737
Provider Business Practice Location Address Fax Number:
888-687-6133
Provider Enumeration Date:
12/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  16371 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 155994 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)