Healthcare Provider Details

I. General information

NPI: 1881121069
Provider Name (Legal Business Name): HANNAH BROCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH WEBB PA

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HUGHES DR # 620
TOLEDO OH
43606-3857
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2126
  • Fax:
Mailing address:
  • Phone: 419-383-3588
  • Fax: 419-383-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006090RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number6754
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.006090RX
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: