Healthcare Provider Details

I. General information

NPI: 1700199221
Provider Name (Legal Business Name): NOSSHEY F HANNA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 SUNBEAM RD
JACKSONVILLE FL
32257-6026
US

IV. Provider business mailing address

4010 SUNBEAM RD
JACKSONVILLE FL
32257-6026
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-8460
  • Fax: 904-268-9809
Mailing address:
  • Phone: 904-268-8460
  • Fax: 904-268-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0043781
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0043781
License Number StateFL

VIII. Authorized Official

Name: NOSSHEY FAWZI HANNA
Title or Position: MEDICAL DOCTOR/PHYSICIAN
Credential: M.D.
Phone: 904-268-8460