Provider Demographics
NPI:1922408962
Name:VARGAS, CARRIE T (CRNA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:T
Last Name:VARGAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:B
Other - Last Name:TURNAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1609
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1609
Mailing Address - Country:US
Mailing Address - Phone:985-230-2198
Mailing Address - Fax:985-230-2159
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-842-3755
Practice Address - Fax:504-842-2036
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2373986Medicaid
MS02725734Medicaid
MS02725734Medicaid