Provider Demographics
NPI:1487621793
Name:DEMARCO, TONI MARIE (CRNA)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:MARIE
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 CARROLLTON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-4047
Mailing Address - Country:US
Mailing Address - Phone:336-423-0215
Mailing Address - Fax:800-264-8472
Practice Address - Street 1:1393 CARROLLTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-4047
Practice Address - Country:US
Practice Address - Phone:336-423-0215
Practice Address - Fax:800-264-8472
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037213367500000X
VA0024168603367500000X
MI4704137811367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4447295Medicaid
MI430F364420OtherBCBSM
MI0F36442236Medicare ID - Type Unspecified
MI4447295Medicaid
MI430F364420OtherBCBSM