Cara Marjorie Anne Cannon

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME124168 Issued in FL

Practice address

5950 South Florida Ave.
Lakeland, FL 33813-2532

Phone

(863) 688-3550

NPI assigned

Jun 4, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: caracannon@lp.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeside Pediatrics North

  • Pediatrics Physician
  • Lakeland, FL
  • NPI 1518973973
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1336469931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2274 CHESTERFIELD CIR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338135837",
            "telephone_number": "863-688-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 SOUTH FLORIDA AVE.",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132532",
            "telephone_number": "863-688-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "CARA",
        "middle_name": "MARJORIE ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-04",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "164586",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME124168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lysmar Karina Cancho I
• Rodolfo Rene Candia, R.PH
• Cannacare Medical Group LLC
• Sara Cannefax
• Walter Wayne Cannefax
• Jeremy Jon Cannon
• Hilda Valbrun Canon, APRN
• John Gerald Galvez Canto, MD
• Theresa Cao, D.O.
• Capernaum Autism Center LLC

• Pediatrics Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.