Healthcare Provider Details

I. General information

NPI: 1205477601
Provider Name (Legal Business Name): WHITNEY HUDSON OCHANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

140 RUSTY GANS DR
PANAMA CITY FL
32408-4510
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1511
  • Fax:
Mailing address:
  • Phone: 205-835-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11004408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: