Individual
TAMA JORDAN HOLLAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3209 S 23RD ST, STE 340, TACOMA, WA 98405-1602
(253) 272-5127
Mailing address
10919 64TH AVE NW, GIG HARBOR, WA 98332-8522
(253) 858-7129
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1-066746
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60311608
WA
367500000X
Certified Registered Nurse Anesthetist
ARNP2698912
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306476000
—
FL
01
—
G2338
BCBS
FL
01
—
G8915279
MDCR PTAN (K)
WA
01
—
G8915280
MDCR PTAN (P)
WA
Enumeration date
07/05/2006
Last updated
01/05/2017
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