Healthcare Provider Details

I. General information

NPI: 1780557421
Provider Name (Legal Business Name): DESTINY N SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 PANAMA CITY BEACH PKWY FL 3
PANAMA CITY BEACH FL
32413-2871
US

IV. Provider business mailing address

1601 INDIANA AVE
LYNN HAVEN FL
32444
UM

V. Phone/Fax

Practice location:
  • Phone: 305-363-2969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: