Provider Demographics
NPI:1366430514
Name:DILACQUA, JOANNE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:DILACQUA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:1 CAPITAL WAY
Practice Address - Street 2:2ND FLOOR ANESTHESIA OFFICES
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2520
Practice Address - Country:US
Practice Address - Phone:609-396-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN327603L367500000X
NJ26NJ00267300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115406RVBOtherNATIONAL GOVERNMENT SERVICES (NJ EMPIRE)
PA076790Q1ROtherREADING MEDICARE
PA076790Medicare PIN
NJ115406RVBOtherNATIONAL GOVERNMENT SERVICES (NJ EMPIRE)