Provider Demographics
NPI:1821079054
Name:SARAB, TAMMY LYNN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:SARAB
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 1:14510 MARSH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2059
Mailing Address - Country:US
Mailing Address - Phone:904-859-8007
Mailing Address - Fax:
Practice Address - Street 1:14510 MARSH VIEW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2059
Practice Address - Country:US
Practice Address - Phone:904-859-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3339662367500000X
WV38199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016999OtherOHIO MEDICAID
FL302747300Medicaid
FL430046651OtherRAILROAD MEDICARE
FLG2410OtherBLUECROSS/BLUESHIELD
FLG2410OtherBLUECROSS/BLUESHIELD
FL302747300Medicaid
FL430046651OtherRAILROAD MEDICARE
WV0067243000Medicaid
WVSA8222482Medicare PIN
OH$$$$$$$$$-00OtherOHIO BUREAU OF WORKERS COMPENSATION
FLG2410OtherBLUECROSS/BLUESHIELD
FLE1681ZMedicare ID - Type Unspecified