Provider Demographics
NPI:1740471812
Name:ALLEN, PAMELA DEMETRICE (CRNA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DEMETRICE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DEMETRICE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1475 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21242367500000X, 367500000X
FLARNP9205766367500000X
NC3830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3085414-00Medicaid
GA204136524CMedicaid
FLG4346OtherBLUE CROSS
GA204136524AMedicaid
FLAE653ZMedicare PIN
FL3085414-00Medicaid