Individual
VINCENT A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3601 TVC, NASHVILLE, TN 37232-0001
(615) 322-3000
Mailing address
3601 TVC, NASHVILLE, TN 37232-0001
(615) 322-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
051295
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009983640
—
AL
05
—
3630981
—
TN
01
—
4034837
BCBS NUMBER
TN
05
—
74004656
—
KY
Enumeration date
08/02/2005
Last updated
06/21/2012
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