Healthcare Provider Details

I. General information

NPI: 1801339940
Provider Name (Legal Business Name): HANNA WOLDEYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 SUWANEE RD
DAYTONA BEACH FL
32114-5916
US

IV. Provider business mailing address

1183 SUWANEE RD
DAYTONA BEACH FL
32114-5916
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-2397
  • Fax:
Mailing address:
  • Phone: 813-997-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9365072
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberRN9365072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: