Provider Demographics
NPI:1881401636
Name:LOEFFLER, JO BETH (CRNA)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:BETH
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:BETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 APPLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-3899
Mailing Address - Country:US
Mailing Address - Phone:901-340-8826
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2173
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152645367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered