Provider Demographics
NPI:1336451608
Name:TANON, CARMEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:TANON
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 1:7925 SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8197
Mailing Address - Country:US
Mailing Address - Phone:407-341-8324
Mailing Address - Fax:
Practice Address - Street 1:7925 SAINT ANDREWS CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8197
Practice Address - Country:US
Practice Address - Phone:407-341-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT3140352367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00HQOtherBC/BC
FL9737610OtherAETNA
FL9737610OtherAETNA