Provider Demographics
NPI:1538205810
Name:TETRICK, LINDA (CRNA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:TETRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BANDERA RD
Mailing Address - Street 2:SUITE 114 416
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2820
Mailing Address - Country:US
Mailing Address - Phone:925-330-0215
Mailing Address - Fax:
Practice Address - Street 1:1250 CAPITOL OF TEXAS HWY S
Practice Address - Street 2:BLDG 3 SUITE 380
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-330-3599
Practice Address - Fax:866-741-4314
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802679367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ13167Medicare UPIN
CABH295AMedicare PIN
CABH295BMedicare PIN