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General NPI Number Information
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NPI Number | 1093747768
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Entity Type | Individual
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Provider Name | CAROL KEENAN ANDERSEN ARNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 122 SERENADE LN
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-1351
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Country | US
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Telephone | 850-319-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 122 SERENADE LN
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-1351
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Country | US
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Telephone | 850-319-3770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 813072
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License Number State | FL
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