MEDICARE: THERESE ANNE HANNA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	775579	MS

General Provider Information

NPI Number	:	1932545480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE ANNE HANNA FNP

Provider Business Mailing Address
First Line	:	5801 SOUTHLAND ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3609
Country	:	US
Telephone Number	:	228-218-5004
Fax Number	:	228-818-9193

Provider Business Practice Location Address
First Line	:	6900 WASHINGTON AVENUE
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564
Country	:	US
Telephone Number	:	228-818-9191
Fax Number	:	228-818-9193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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