Provider Demographics
NPI:1245103365
Name:CANNAN, CAROLINE JANSKI
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JANSKI
Last Name:CANNAN
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 1:1414 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4709
Mailing Address - Country:US
Mailing Address - Phone:325-668-8685
Mailing Address - Fax:
Practice Address - Street 1:1414 TANGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4709
Practice Address - Country:US
Practice Address - Phone:325-668-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant