Provider Demographics
NPI:1679532915
Name:PANDO, PAULA BLANCO (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:BLANCO
Last Name:PANDO
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:800-642-1999
Mailing Address - Fax:248-646-0361
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:800-642-1999
Practice Address - Fax:248-646-0361
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN680312163W00000X
SC3144367500000X
FLARNP9256888367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308367500Medicaid
FL308367500Medicaid