Provider Demographics
NPI:1992190284
Name:OSBORNE, TRAVIS (CRNA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:OSBORNE
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 1:3809 VALLEY VIEW RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3375
Mailing Address - Country:US
Mailing Address - Phone:512-924-1858
Mailing Address - Fax:
Practice Address - Street 1:1402 HOMESPUN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3041
Practice Address - Country:US
Practice Address - Phone:512-924-1858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMSL257722NC163W00000X
AZCRNA1134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse