Healthcare Provider Details

I. General information

NPI: 1548092018
Provider Name (Legal Business Name): MARICAR BANA DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 US HIGHWAY 17 STE 18
FLEMING ISLAND FL
32003-8250
US

IV. Provider business mailing address

5011 GATE PARKWAY BLDG 100 SUITE 100 PMB1026
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-544-3608
  • Fax: 904-544-3614
Mailing address:
  • Phone: 904-717-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11034751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: