Healthcare Provider Details

I. General information

NPI: 1104550581
Provider Name (Legal Business Name): ISABELLA ALLEN PACANINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 09/22/2022
Reactivation Date: 05/19/2026

III. Provider practice location address

5400 S UNIVERSITY DR STE 406
DAVIE FL
33328-5311
US

IV. Provider business mailing address

5400 S UNIVERSITY DR
DAVIE FL
33328-5312
US

V. Phone/Fax

Practice location:
  • Phone: 754-222-2048
  • Fax:
Mailing address:
  • Phone: 754-222-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: