Healthcare Provider Details

I. General information

NPI: 1639252372
Provider Name (Legal Business Name): JOANNA Q HANNAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S STATE ROAD 434
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

1361 BLACK WILLOW TRL # 1191
ALTAMONTE SPRINGS FL
32714-1215
US

V. Phone/Fax

Practice location:
  • Phone: 407-587-8600
  • Fax:
Mailing address:
  • Phone: 407-416-4555
  • Fax: 407-329-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 3623
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: