Provider Demographics
NPI:1114132388
Name:TANGUAY, JENNIFER ROSS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSS
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ROSS
Other - Last Name:FRISCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:889 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2923
Mailing Address - Country:US
Mailing Address - Phone:817-908-7161
Mailing Address - Fax:206-267-0410
Practice Address - Street 1:1275 NE FRANKLIN AVE STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311
Practice Address - Country:US
Practice Address - Phone:360-377-0803
Practice Address - Fax:360-373-3966
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60215565367500000X
WAAP60215565367500000X
IL041358503367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered