Individual
ETTA MARIE AYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1600 HOSPITAL PKWY, BEDFORD, TX 76022-6913
(817) 355-7800
(817) 355-7805
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5007
(972) 715-5682
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
216964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088599803
—
TX
05
—
155484203
—
TX
01
—
430047353
RAILROAD
TX
01
—
81012U
BCBS
TX
Enumeration date
03/02/2006
Last updated
06/03/2010
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