Provider Demographics
NPI:1548092018
Name:BANA, MARICAR (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARICAR
Middle Name:
Last Name:BANA
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 GATE PARKWAY BLDG 100
Mailing Address - Street 2:SUITE 100 PMB1026
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-717-5220
Mailing Address - Fax:
Practice Address - Street 1:5000 US HIGHWAY 17 STE 18
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8250
Practice Address - Country:US
Practice Address - Phone:904-544-3608
Practice Address - Fax:904-544-3614
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health