Provider Demographics
NPI:1245829902
Name:MEDOLLA, ANITA (APRN CRNA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MEDOLLA
Suffix:
Gender:F
Credentials:APRN CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 SW SEAHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4249
Mailing Address - Country:US
Mailing Address - Phone:631-896-8816
Mailing Address - Fax:
Practice Address - Street 1:9123 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5990
Practice Address - Country:US
Practice Address - Phone:561-622-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039849367500000X
FL9460694163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine