Provider Demographics
NPI:1932175031
Name:KILMARTIN, PAUL F (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:KILMARTIN
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 1:6820 BERRYHILL STREET
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-2265
Mailing Address - Country:US
Mailing Address - Phone:850-981-1195
Mailing Address - Fax:850-981-2561
Practice Address - Street 1:6820 BERRYHILL STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2265
Practice Address - Country:US
Practice Address - Phone:850-981-1195
Practice Address - Fax:850-981-2561
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA 23455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306633900Medicaid
FLG36112OtherMEDICARE
AL009976515OtherMEDICARE
FLG36112OtherMEDICARE