Doctor Name: | MS. INGRID MARION CAVANAUGH |
NPI Number: | 1023209483 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA-9102714 |
Business Practice Address: | 3702 Washington St Ste 201 Hollywood, FL - 330218283 |
Business Phone Number: | 9549861811 |
Business Fax Number: | 9549869452 |
Mailing Address: | 7703 Floyd Curl Dr, SAN ANTONIO |
State: | TX |
Postal Code: | 782293901 |
Phone Number: | 2103582078 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2007 |
NPI Last Update Date: | 08/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-9102714 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |