Healthcare Provider Details

I. General information

NPI: 1093645004
Provider Name (Legal Business Name): PANAMA CITY PPEC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST
PANAMA CITY FL
32404-5831
US

IV. Provider business mailing address

3520 E 15TH ST
PANAMA CITY FL
32404-5831
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-1312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED M. ABDELLI
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-960-5045