Provider Demographics
NPI:1386809903
Name:SILVIA, ROBERT DALE (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:SILVIA
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 1:708 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3901
Mailing Address - Country:US
Mailing Address - Phone:731-541-7070
Mailing Address - Fax:731-541-7075
Practice Address - Street 1:1804 HIGHWAY 45 BYP
Practice Address - Street 2:SUITE 604
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4436
Practice Address - Country:US
Practice Address - Phone:731-660-8759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508598Medicaid
TNP00854616OtherRR MEDICARE
TNP00854616OtherRR MEDICARE