Healthcare Provider Details

I. General information

NPI: 1881482404
Provider Name (Legal Business Name): RAINA RAGAN HOLLAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W 23RD ST
PANAMA CITY FL
32405
US

IV. Provider business mailing address

7179 HATTERAS BLVD
PANAMA CITY FL
32404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 850-532-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11038962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: