Provider Demographics
NPI:1437189909
Name:PAUGAM, JACQUELINE E (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:PAUGAM
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 1:1110 THRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3151
Mailing Address - Country:US
Mailing Address - Phone:786-200-3279
Mailing Address - Fax:786-200-3279
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:CEDARS DEPARTMENT OF ANESTHESIA
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5416
Practice Address - Fax:954-964-6084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1-488-352367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304608700Medicaid
FL304608700Medicaid