Healthcare Provider Details

I. General information

NPI: 1366116733
Provider Name (Legal Business Name): MRS. HANNAH ELIZABETH TOLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 10TH ST
MALONE FL
32445-3128
US

IV. Provider business mailing address

5408 10TH ST
MALONE FL
32445-3128
US

V. Phone/Fax

Practice location:
  • Phone: 689-262-6576
  • Fax: 689-262-6575
Mailing address:
  • Phone: 689-262-6576
  • Fax: 689-262-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: