Provider Demographics
NPI:1659457414
Name:SHERRILL, JERRY LIN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:LIN
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:LIN
Other - Middle Name:
Other - Last Name:SHERRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:110 29TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1448
Mailing Address - Country:US
Mailing Address - Phone:615-327-4304
Mailing Address - Fax:615-327-7940
Practice Address - Street 1:110 29TH AVE N STE 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1448
Practice Address - Country:US
Practice Address - Phone:615-327-4304
Practice Address - Fax:615-327-7940
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN108551163W00000X
TNAPN10064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01037074OtherAMERIGROUP COMMUNITY CARE-TNCARE ONLY
TN4073073OtherBLUE CROSS BLUE SHIELD OF TN
TNP00103434OtherRR MEDICARE
TN3629350Medicaid
TN103I430508Medicare PIN
TN3629350Medicare PIN