Provider Demographics
NPI:1548390602
Name:MADISON, ANN LOUIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LOUIS
Last Name:MADISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:LOUIS
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8116 CLUSTER RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4037
Mailing Address - Country:US
Mailing Address - Phone:850-785-4599
Mailing Address - Fax:
Practice Address - Street 1:615 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3623
Practice Address - Country:US
Practice Address - Phone:850-747-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19879163WC0200X
FLRN9227088163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine