Healthcare Provider Details

I. General information

NPI: 1558022426
Provider Name (Legal Business Name): HANNA ELISABETH HEMMATI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 84TH AVE STE 102
PLANTATION FL
33324-2729
US

IV. Provider business mailing address

220 SW 84TH AVE STE 102
PLANTATION FL
33324-2729
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-1530
  • Fax: 954-720-6540
Mailing address:
  • Phone: 954-349-2345
  • Fax: 954-349-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9117819
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9117819
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: