Provider Demographics
NPI:1023101227
Name:TESSIER, JAIME (CRNA)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:TESSIER
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 1:8410 FRONT GATE CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9511
Mailing Address - Country:US
Mailing Address - Phone:423-488-1983
Mailing Address - Fax:
Practice Address - Street 1:8410 FRONT GATE CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9511
Practice Address - Country:US
Practice Address - Phone:423-488-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167645163W00000X
TN14408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA734816548AMedicaid
GA734816548AMedicaid