Provider Demographics
NPI:1164676177
Name:PUCEK, SARAH Y (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:Y
Last Name:PUCEK
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 1:131 TUCKER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4055
Mailing Address - Country:US
Mailing Address - Phone:931-388-6404
Mailing Address - Fax:
Practice Address - Street 1:131 TUCKER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4055
Practice Address - Country:US
Practice Address - Phone:931-388-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011444207L00000X
TNRN0000084350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology