Provider Demographics
NPI:1518493352
Name:KERNIZAN, DAPHNEY (DO)
Entity Type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:
Last Name:KERNIZAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4539
Mailing Address - Country:US
Mailing Address - Phone:407-650-7715
Mailing Address - Fax:407-567-5931
Practice Address - Street 1:2202 STATE AVE STE 102
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4539
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-567-5931
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00239752080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology