Healthcare Provider Details

I. General information

NPI: 1629547187
Provider Name (Legal Business Name): HANNA ST. DENIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W DR MLK BLVD STE 300
TAMPA FL
33607-6392
US

IV. Provider business mailing address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1853
US

V. Phone/Fax

Practice location:
  • Phone: 813-805-8108
  • Fax:
Mailing address:
  • Phone: 172-747-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: