Healthcare Provider Details

I. General information

NPI: 1235404641
Provider Name (Legal Business Name): KELLY MARIE CABANA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 19TH ST
PANAMA CITY FL
32405-4647
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-3040
  • Fax: 850-785-2552
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9165075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: