Healthcare Provider Details

I. General information

NPI: 1316929631
Provider Name (Legal Business Name): PAMELA ELLEN KILMARTIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 BERRYHILL ST
MILTON FL
32570-2265
US

IV. Provider business mailing address

6820 BERRYHILL ST
MILTON FL
32570-2265
US

V. Phone/Fax

Practice location:
  • Phone: 850-981-1195
  • Fax: 850-981-2561
Mailing address:
  • Phone: 850-981-1195
  • Fax: 850-981-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA36544
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2581152
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number238395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: