Provider Demographics
NPI:1336325653
Name:BALMACEDA, FERNANDO A III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:A
Last Name:BALMACEDA
Suffix:III
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 1:154 CUDE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2202
Mailing Address - Country:US
Mailing Address - Phone:615-865-6268
Mailing Address - Fax:615-868-7378
Practice Address - Street 1:154 CUDE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2202
Practice Address - Country:US
Practice Address - Phone:615-865-6268
Practice Address - Fax:615-868-7378
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78144367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered