Provider Demographics
NPI:1700885837
Name:TZVETCOFF, SANDRA ANNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNE
Last Name:TZVETCOFF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ANNE
Other - Last Name:ROEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 241062
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1062
Mailing Address - Country:US
Mailing Address - Phone:425-358-0012
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5229
Practice Address - Country:US
Practice Address - Phone:907-550-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00132233163W00000X
WAAP30005078367500000X
AK30375367500000X
AKRN352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624685Medicaid
WA8850426Medicare ID - Type UnspecifiedSEATTLE CLINIC
WA8850425Medicare ID - Type UnspecifiedSEQUIM CLINIC
WA8850424Medicare ID - Type UnspecifiedSMOKEY POINT CLINIC
WA9624685Medicaid
WAAB38192Medicare PIN