Provider Demographics
NPI:1609829589
Name:HARB, HERBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:HARB
Suffix:
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:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-1252
Mailing Address - Country:US
Mailing Address - Phone:615-396-4643
Mailing Address - Fax:615-396-6748
Practice Address - Street 1:301 N UNIVERSITY ST
Practice Address - Street 2:STE 104
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3900
Practice Address - Country:US
Practice Address - Phone:615-396-4643
Practice Address - Fax:615-396-6748
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN56547367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4182572OtherBCBS EFFECTIVE 5/1/08
TN3076776OtherBLUE CROSS BLUE SHIELD
TN430010064OtherRR MEDICARE
TN3606168Medicaid
TN3606168Medicaid