Provider Demographics
NPI:1306881636
Name:GREEN, JANIS KAY (ARNP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:KAY
Last Name:GREEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GULF COAST OUTPATIENT CLINIC, NAVAL SUPPORT ACTIVITY PC
Mailing Address - Street 2:101 VERNON AVE STE 387
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7018
Mailing Address - Country:US
Mailing Address - Phone:850-630-7000
Mailing Address - Fax:
Practice Address - Street 1:GULF COAST OUTPATIENT CLINIC, NAVAL SUPPORT ACTIVITY PC
Practice Address - Street 2:101 VERNON AVE STE 387
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-7018
Practice Address - Country:US
Practice Address - Phone:850-630-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER047186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily