Individual
REBECCA SUZANNE ISABELLE CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4951 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 473-0100
(850) 473-0500
Mailing address
4951 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 473-0100
(850) 473-0500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN11011563
FL
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN11011563
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109796100
—
FL
Enumeration date
02/18/2021
Last updated
03/31/2022
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