Provider Demographics
NPI:1225020928
Name:CARDINALE, CAROL (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:CARDINALE
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 1:1989 SW HILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1183
Mailing Address - Country:US
Mailing Address - Phone:772-398-3531
Mailing Address - Fax:772-398-3575
Practice Address - Street 1:1800 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7521
Practice Address - Country:US
Practice Address - Phone:772-398-3531
Practice Address - Fax:772-398-3575
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195573367500000X
FLARNP 9268903367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR50096Medicare UPIN
NYR4A051Medicare ID - Type Unspecified