Healthcare Provider Details

I. General information

NPI: 1376858266
Provider Name (Legal Business Name): RENEE HANEY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 W MARTIN LUTHER KING JR BLVD SUITE 100A
TAMPA FL
33603-3135
US

IV. Provider business mailing address

718 W MARTIN LUTHER KING JR BLVD SUITE 100A
TAMPA FL
33603-3135
US

V. Phone/Fax

Practice location:
  • Phone: 813-224-0355
  • Fax:
Mailing address:
  • Phone: 813-224-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE HANEY
Title or Position: PRESIDENT
Credential: MD
Phone: 813-224-0355