Provider Demographics
NPI:1568464089
Name:PENNINGTON, ROBERT LANCE (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LANCE
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-8965
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-2436
Practice Address - Country:US
Practice Address - Phone:850-934-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9210408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00164745OtherRAILROAD MEDICARE
FL306094200Medicaid
AL009945425Medicaid
AL59168859OtherBLUE CROSS & BLUE SHIELD
FLG3419OtherBLUE CROSS & BLUE SHIELD