Healthcare Provider Details

I. General information

NPI: 1558781534
Provider Name (Legal Business Name): MARY JANSSON CARMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HARRISON AVE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

1900 HARRISON AVE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1668
  • Fax: 850-785-2123
Mailing address:
  • Phone: 850-769-1668
  • Fax: 850-785-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP: RN171898
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: