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General NPI Number Information
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NPI Number | 1497596480
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Entity Type | Individual
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Provider Name | COLLEEN ROSE PAGOADA APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2003 WILSON AVE UNIT A
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City | PANAMA CITY
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State | FL
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Zip | 32405-4532
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Country | US
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Telephone | 850-784-9991
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Fax | 850-163-8361
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Provider Business Mailing Address
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Address Line | 5004 PRETTY WAY
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City | PANAMA CITY
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State | FL
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Zip | 32404-3089
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Country | US
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Telephone | 985-774-1497
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 11032971
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License Number State | FL
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