Provider Demographics
NPI:1528117876
Name:CATES, JACKIE LEE JR (CRNA)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LEE
Last Name:CATES
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 1:2154 DUCK SLOUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:2154 DUCK SLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5073
Practice Address - Country:US
Practice Address - Phone:727-937-6020
Practice Address - Fax:866-665-2702
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643079367500000X
FLAPRN9178585367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered