Provider Demographics
NPI:1316928443
Name:JENNINGS, THOMAS A (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22909 63RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-7047
Mailing Address - Country:US
Mailing Address - Phone:941-322-1535
Mailing Address - Fax:
Practice Address - Street 1:601 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8610
Practice Address - Country:US
Practice Address - Phone:941-745-2727
Practice Address - Fax:941-745-2112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2622842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P0023240OtherRAILROAD MEDICARE
FLG1562OtherBLUE CROSS BLUE SHIELD
G1562Medicare ID - Type Unspecified