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General NPI Number Information
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NPI Number | 1164128724
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Entity Type | Individual
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Provider Name | HANNAH KATHRYN WISNIEWSKI
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 23 BUFFALO GROVE PL
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City | PALM COAST
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State | FL
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Zip | 32137-9462
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Country | US
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Telephone | 386-283-1972
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 917770
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 813-821-8038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9120291
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9120291
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License Number State | FL
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