Provider Demographics
NPI:1982686101
Name:FAGAN, RACHEL S (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:FAGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:MEDICAL CENTER CLINIC ANESTHESIA
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8319
Mailing Address - Fax:850-969-2958
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-474-8319
Practice Address - Fax:850-969-2958
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3176802367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered