Provider Demographics
NPI:1417955329
Name:MCCUEN, TATIANA P (CRNA)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:P
Last Name:MCCUEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:FITZWATER AKININA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 TUSCARORA RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-8985
Mailing Address - Country:US
Mailing Address - Phone:910-322-5787
Mailing Address - Fax:
Practice Address - Street 1:205 TUSCARORA RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-8985
Practice Address - Country:US
Practice Address - Phone:910-322-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127620367500000X
FLARNP3243742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051616Medicaid
NC2600446AMedicare ID - Type Unspecified
NC8051616Medicaid
HIH102490Medicare PIN