Provider Demographics
NPI:1194713727
Name:ROBINSON, PAMELA NICHOLS (CRNA)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:NICHOLS
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2820 1ST AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-2344
Mailing Address - Country:US
Mailing Address - Phone:404-275-0768
Mailing Address - Fax:
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-487-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060719367500000X
FLARNP3278022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194713727OtherTRICARE
FLG3385OtherBLUE CROSS BLUE SHIELD FL
FL307618100Medicaid
GAS55051Medicare PIN