Provider Demographics
NPI:1306671763
Name:ESTABA, CANAIMA CARIBAY
Entity type:Individual
Prefix:
First Name:CANAIMA
Middle Name:CARIBAY
Last Name:ESTABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 BEARGRASS RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-9182
Mailing Address - Country:US
Mailing Address - Phone:407-705-8915
Mailing Address - Fax:
Practice Address - Street 1:6941 BEARGRASS RD
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:FL
Practice Address - Zip Code:34773-9182
Practice Address - Country:US
Practice Address - Phone:407-705-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1720-P.A.363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical