Provider Demographics
NPI:1033158118
Name:PERREAULT, JUDITH CAROL (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:CAROL
Last Name:PERREAULT
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 1:16806 INNOCENTE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2318
Mailing Address - Country:US
Mailing Address - Phone:850-234-1868
Mailing Address - Fax:850-234-1468
Practice Address - Street 1:16806 INNOCENTE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2318
Practice Address - Country:US
Practice Address - Phone:850-234-1868
Practice Address - Fax:850-234-1468
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9182205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6861Medicare ID - Type UnspecifiedCRNA