Provider Demographics
NPI:1508848904
Name:CALVIN, CAROLYN KAY (WHCNP/ANP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
Last Name:CALVIN
Suffix:
Gender:F
Credentials:WHCNP/ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 ASHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4277
Mailing Address - Country:US
Mailing Address - Phone:808-778-9156
Mailing Address - Fax:
Practice Address - Street 1:325TH MEDICAL GROUP
Practice Address - Street 2:340 MAGNOLIA CIRCLE
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5604
Practice Address - Country:US
Practice Address - Phone:850-283-7491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150121NP363LW0102X
OR200150122NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health