Provider Demographics
NPI:1619761921
Name:CANNON, GEORGE P (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:CANNON
Suffix:
Gender:
Credentials: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 1:2637 W STATE ROAD 426 STE 1021
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8325
Mailing Address - Country:US
Mailing Address - Phone:321-340-3490
Mailing Address - Fax:
Practice Address - Street 1:2637 W STATE ROAD 426 STE 1021
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8325
Practice Address - Country:US
Practice Address - Phone:321-340-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health