Provider Demographics
NPI:1316929631
Name:KILMARTIN, PAMELA ELLEN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELLEN
Last Name:KILMARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 BERRYHILL ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-2265
Mailing Address - Country:US
Mailing Address - Phone:850-981-1195
Mailing Address - Fax:850-981-2561
Practice Address - Street 1:6820 BERRYHILL ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2265
Practice Address - Country:US
Practice Address - Phone:850-981-1195
Practice Address - Fax:850-981-2561
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36544367500000X
FLARNP2581152367500000X
MA238395367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3066347Medicaid
FL3066347OtherMEDICARE