Provider Demographics
NPI:1174782601
Name:CANTRELL, JENNIFER L (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 ARROWHEAD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1254
Mailing Address - Country:US
Mailing Address - Phone:770-478-9877
Mailing Address - Fax:770-478-2908
Practice Address - Street 1:405 ARROWHEAD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1254
Practice Address - Country:US
Practice Address - Phone:770-478-9877
Practice Address - Fax:770-478-2908
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered