Individual
MELLISSA DIANNE PENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4 OCEAN VIEW DR, GULF BREEZE, FL 32561-2436
(850) 934-8157
Mailing address
4 OCEAN VIEW DR, GULF BREEZE, FL 32561-2436
(850) 934-8157
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9212211
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59170994
BLUE CROSS & BLUE SHIELD
AL
01
—
G3473
BLUE CROSS & BLUE SHIELD
FL
Enumeration date
08/15/2005
Last updated
07/08/2007
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