Provider Demographics
NPI:1659621100
Name:HACK, JAMI LEA (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LEA
Last Name:HACK
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 1:7887 N LA CHOLLA BLVD
Mailing Address - Street 2:APT 3175
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4313
Mailing Address - Country:US
Mailing Address - Phone:605-390-1101
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE # 7-11A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-629-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR031699163W00000X
AZCRNA0902367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse