Provider Demographics
NPI:1407230998
Name:CANCEL, ISIS
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:CANCEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 COURTNEY CHASE CIR
Mailing Address - Street 2:APT 711
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8148
Mailing Address - Country:US
Mailing Address - Phone:407-910-3862
Mailing Address - Fax:
Practice Address - Street 1:1136 COURTNEY CHASE CIRCLE
Practice Address - Street 2:APT 711
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:407-910-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1101075171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4928293901OtherCIGNA