Provider Demographics
NPI:1003530213
Name:TRANQUIL TIDES ANESTHESIA LLC
Entity type:Organization
Organization Name:TRANQUIL TIDES ANESTHESIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:POPPY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:325-675-6466
Mailing Address - Street 1:3301 S 14TH ST STE 16180
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5015
Mailing Address - Country:US
Mailing Address - Phone:325-675-6466
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:2 NORTH AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2303
Practice Address - Country:US
Practice Address - Phone:443-643-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty