Healthcare Provider Details

I. General information

NPI: 1902044696
Provider Name (Legal Business Name): ALLISON ANN GOLDFARB CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON ANN COLEMAN

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD COASTAL ANESTHESIOLOGY CONSULTANTS, P.L.
SAINT AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

PO BOX 24906
MIAMI FL
33102-4906
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4478
  • Fax: 904-819-4993
Mailing address:
  • Phone: 904-819-4478
  • Fax: 904-819-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1612672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: