Provider Demographics
NPI:1447216650
Name:PADUA, CORAZON N (CRNA)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:N
Last Name:PADUA
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 1:2811 ROCKCREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4656
Mailing Address - Country:US
Mailing Address - Phone:901-388-7706
Mailing Address - Fax:
Practice Address - Street 1:5744 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2061
Practice Address - Country:US
Practice Address - Phone:901-797-9711
Practice Address - Fax:901-797-9771
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36692367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3089050OtherBCBS
TN3631751Medicaid
TN3631751Medicaid