Individual
JEREMY BLAKE EAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-2000
Mailing address
PO BOX 840853, DALLAS, TX 75284-2087
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
915308
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
1177067
TX
Other
Enumeration date
07/24/2024
Last updated
11/14/2024
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