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Individual

JACOB D HANTLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1849 W ORCHID LN, CHANDLER, AZ 85224-9034
(480) 241-3769
(480) 393-4109
Mailing address
1849 W ORCHID LN, CHANDLER, AZ 85224-9034
(480) 241-3769
(480) 393-4109

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN139385
AZ
163W00000X
Registered Nurse
RN9307995
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0786
AZ

Other

Enumeration date
07/25/2011
Last updated
09/16/2011
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