Provider Demographics
NPI:1427091479
Name:TASSIN, MYRON JUDE JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:JUDE
Last Name:TASSIN
Suffix:JR
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 1:149 DRINKWATER BLVD.
Mailing Address - Street 2:
Mailing Address - City:BAY ST. LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520
Mailing Address - Country:US
Mailing Address - Phone:228-467-8600
Mailing Address - Fax:
Practice Address - Street 1:149 DRINKWATER BLVD.
Practice Address - Street 2:
Practice Address - City:BAY ST. LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-467-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875521367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered