Provider Demographics
NPI:1942291174
Name:CARNEY, MARTIN JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:CARNEY
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 1:1436 DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4224
Mailing Address - Country:US
Mailing Address - Phone:727-372-6991
Mailing Address - Fax:727-372-6991
Practice Address - Street 1:6600 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1971
Practice Address - Country:US
Practice Address - Phone:727-842-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1831672367500000X
PARN229116L367500000X
TNAPN0000009971367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1039OtherBC/BS
FLG1039ZMedicare ID - Type Unspecified
FLR03459Medicare UPIN