Provider Demographics
NPI:1386727634
Name:PERRYMAN, PAULA LEIGH (CRNA)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LEIGH
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:LEIGH
Other - Last Name:KORNAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4535 ECTON LN E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1893
Mailing Address - Country:US
Mailing Address - Phone:904-642-5672
Mailing Address - Fax:
Practice Address - Street 1:1800 BARRS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4704
Practice Address - Country:US
Practice Address - Phone:904-308-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL021887367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0599ZMedicare ID - Type Unspecified