=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730274895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARA LYN CAKANS ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 09/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 BARRACUDA LN
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-367-2600
-----------------------------------------------------
Fax | 305-367-4573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 BARRACUDA LN
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-367-2600
-----------------------------------------------------
Fax | 305-367-4573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9170958
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------