Healthcare Provider Details

I. General information

NPI: 1962943795
Provider Name (Legal Business Name): CHRISTINA HANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 KIRBY LOOP RD
FORT PIERCE FL
34981-5345
US

IV. Provider business mailing address

2001 SW PROVIDENCE PL
PORT SAINT LUCIE FL
34953-4356
US

V. Phone/Fax

Practice location:
  • Phone: 772-577-6964
  • Fax:
Mailing address:
  • Phone: 561-644-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ 7997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: