Provider Demographics
NPI:1750684494
Name:HULSEBUS, TYSON A (CRNA)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:A
Last Name:HULSEBUS
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 204097
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-4097
Mailing Address - Country:US
Mailing Address - Phone:706-855-9860
Mailing Address - Fax:706-860-7124
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-737-9250
Practice Address - Fax:706-733-0697
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered