Basic Information
| Provider Information | |||||||||
| NPI: | 1902044696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDFARB | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLEMAN | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 24906 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331024906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048194478 | ||||||||
| FaxNumber: | 9048194933 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HEALTH PARK BLVD | ||||||||
| Address2: | COASTAL ANESTHESIOLOGY CONSULTANTS, P.L. | ||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048194478 | ||||||||
| FaxNumber: | 9048194993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 06/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP1612672 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0007428-00 | 05 | FL | MEDICAID | 989112603A | 05 | GA | MEDICAID |