Provider Demographics
NPI:1093747768
Name:ANDERSEN, CAROL KEENAN (ARNP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:KEENAN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:122 SERENADE LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-1351
Mailing Address - Country:US
Mailing Address - Phone:850-319-3770
Mailing Address - Fax:
Practice Address - Street 1:122 SERENADE LN
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-1351
Practice Address - Country:US
Practice Address - Phone:850-319-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL813072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0305272OtherAM ACAD NURSEPRACTITIONES