Provider Demographics
NPI:1518338839
Name:CANNION, LAKEECIA (DNP, ARNP-C)
Entity type:Individual
Prefix:DR
First Name:LAKEECIA
Middle Name:
Last Name:CANNION
Suffix:
Gender:F
Credentials:DNP, ARNP-C
Other - Prefix:
Other - First Name:LAKEECIA
Other - Middle Name:CHANELL
Other - Last Name:GREEN MILBRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN-C
Mailing Address - Street 1:PO BOX 60976
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32906-0976
Mailing Address - Country:US
Mailing Address - Phone:321-795-7386
Mailing Address - Fax:
Practice Address - Street 1:775 MALABAR RD
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3120
Practice Address - Country:US
Practice Address - Phone:321-722-8435
Practice Address - Fax:321-722-8486
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171717363LA2200X
FLRN9171717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016947100Medicaid