Provider Demographics
NPI:1386380566
Name:JLA ANESTHESIA SERVICES PA
Entity type:Organization
Organization Name:JLA ANESTHESIA SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CRNA
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:813-263-3195
Mailing Address - Street 1:11022 N 28TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5634
Mailing Address - Country:US
Mailing Address - Phone:602-424-7967
Mailing Address - Fax:
Practice Address - Street 1:19052 N R H JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4401
Practice Address - Country:US
Practice Address - Phone:623-975-2020
Practice Address - Fax:623-975-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty