Individual
HOLLY C TATE CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
110 29TH AVE N, NASHVILLE, TN 37203-1401
(615) 327-4304
Mailing address
110 29TH AVE N, NASHVILLE, TN 37203-1448
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
73958
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3636169
—
TN
01
—
4120866
BCBS
TN
05
—
74011503
—
KY
Enumeration date
01/23/2006
Last updated
09/24/2007
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