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NPI Code Detail

MEDICARE: MS. PAMELA NICHOLS ROBINSON CRNA

MEDICARE: MS. PAMELA NICHOLS ROBINSON CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN060719GA
2367500000XCertified Registered Nurse AnesthetistARNP3278022FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11194713727OTHERFLTRICARE
2G3385OTHERFLBLUE CROSS BLUE SHIELD FL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194713727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA NICHOLS ROBINSON CRNA
Provider Business Mailing Address
First Line : 2820 1ST AVE
Second Line : APT. A
City : FERNANDINA BEACH
State : FL
Zip : 32034-2344
Country : US
Telephone Number : 404-275-0768
Fax Number :
Provider Business Practice Location Address
First Line : 404 NW HALL OF FAME DR
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-4833
Country : US
Telephone Number : 386-487-3930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 01/25/2016

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