Individual
MRS. CAROL S MIRUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1103 FORTUNE AVE, PANAMA CITY, FL 32401-1831
(850) 769-6188
(850) 769-1261
Mailing address
1103 FORTUNE AVE, PANAMA CITY, FL 32401-1831
(850) 769-6188
(850) 769-1261
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
MT1140
FL
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN56361-2
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z2167
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/20/2006
Last updated
09/11/2025
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