Provider Demographics
NPI:1902929854
Name:TANESTHESIA, INC
Entity Type:Organization
Organization Name:TANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:870-687-3985
Mailing Address - Street 1:249 DALLAS 262
Mailing Address - Street 2:
Mailing Address - City:SPARKMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71763-8690
Mailing Address - Country:US
Mailing Address - Phone:870-678-3985
Mailing Address - Fax:870-678-2105
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4604
Practice Address - Country:US
Practice Address - Phone:870-836-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156044001Medicaid
AR1659438448OtherINDIVIDUAL NPI
AR$$$$$$$$$OtherSOCIAL SECURITY
AR430492936OtherSOCIAL SECURITY
AR=========OtherTAX ID
ARQ42649Medicare UPIN