Healthcare Provider Details

I. General information

NPI: 1003698689
Provider Name (Legal Business Name): ANAIYA D RUANO OLIVERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

IV. Provider business mailing address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-0329
  • Fax: 844-563-8135
Mailing address:
  • Phone: 850-769-0329
  • Fax: 844-563-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: