Provider Demographics
NPI:1396722609
Name:JAROS, SUSAN ROBERTA (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROBERTA
Last Name:JAROS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 OLD MOSS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1611
Mailing Address - Country:US
Mailing Address - Phone:214-498-8648
Mailing Address - Fax:
Practice Address - Street 1:8408 OLD MOSS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1611
Practice Address - Country:US
Practice Address - Phone:214-498-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX425124367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81000UOtherBCBS
TX088925505Medicaid
TX088925504Medicaid
TX088925507Medicaid
TX430048920OtherRAILROAD
TX088925504Medicaid
TXTXB153952Medicare PIN
TXTXB117600Medicare PIN
R56255Medicare UPIN
TX088925505Medicaid