Individual
TYLER BLAKE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1802 6TH AVE S # NP7401-C, BIRMINGHAM, AL 35233-1932
(205) 975-3737
Mailing address
269 G B SANDERS DR, ASHVILLE, AL 35953-3018
(256) 630-9778
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-134728
AL
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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