Healthcare Provider Details

I. General information

NPI: 1124777552
Provider Name (Legal Business Name): HANNAH PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

IV. Provider business mailing address

250 W 15TH ST
APOPKA FL
32703-7012
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1000
  • Fax:
Mailing address:
  • Phone: 407-252-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: