Provider Demographics
NPI:1154500932
Name:ALMANZAR-ALCANTARA, MARTHA (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:ALMANZAR-ALCANTARA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100806
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0806
Mailing Address - Country:US
Mailing Address - Phone:800-901-2102
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:700 WEST OAK STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4996
Practice Address - Country:US
Practice Address - Phone:407-846-2266
Practice Address - Fax:407-518-3616
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9261884367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308827800Medicaid
FLG4391OtherBLUE CROSS BLUE SHIELD FL
FLAG570ZMedicare PIN