Provider Demographics
NPI:1659499952
Name:TYNDALL, LAURA A (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:TILLOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2930
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2930
Mailing Address - Country:US
Mailing Address - Phone:844-468-9496
Mailing Address - Fax:855-630-1300
Practice Address - Street 1:975 E. THIRD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-602-8400
Practice Address - Fax:423-602-8401
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN59978163W00000X
GARN142582367500000X
TNAPN10743367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009930325Medicaid
TN3627259Medicaid
NC8052324Medicaid
TN3109914OtherBLUE CROSS BLUE SHIELD OF TN
430048582OtherRAILROAD MEDICARE
GA000801908AMedicaid
GAN471843OtherWELLCARE (GA MEDICAID)
TN3627259Medicare PIN