Healthcare Provider Details

I. General information

NPI: 1013710409
Provider Name (Legal Business Name): KAYLA ANN HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ANN KORKOWSKI

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

175 OLD MURDOCH RD APT 404
NEWPORT NC
28570-6453
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-7100
  • Fax:
Mailing address:
  • Phone: 763-229-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: