Healthcare Provider Details

I. General information

NPI: 1023361524
Provider Name (Legal Business Name): JESSICA HAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2012
Last Update Date: 10/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAWGRASS CORPORATE PKWY PARKWAY SUITE 106
SUNRISE FL
33325-6244
US

IV. Provider business mailing address

4930 72ND ST E
BRADENTON FL
34203-7946
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-1112
  • Fax:
Mailing address:
  • Phone: 941-527-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: