Provider Demographics
NPI:1902044696
Name:GOLDFARB, ALLISON ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ANN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24906
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102-4906
Mailing Address - Country:US
Mailing Address - Phone:904-819-4478
Mailing Address - Fax:904-819-4933
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:COASTAL ANESTHESIOLOGY CONSULTANTS, P.L.
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5784
Practice Address - Country:US
Practice Address - Phone:904-819-4478
Practice Address - Fax:904-819-4993
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1612672367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007428-00Medicaid
GA989112603AMedicaid
FLBL402YMedicare PIN