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General NPI Number Information
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NPI Number | 1275426983
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Entity Type | Individual
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Provider Name | HANNA ANTLEY
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 4920 NE STALLINGS DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1254
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Country | US
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Telephone | 936-569-9481
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Fax |
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Provider Business Mailing Address
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Address Line | 1068 COUNTY ROAD 4550
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City | PENNINGTON
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State | TX
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Zip | 75856-6501
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Country | US
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Telephone | 936-546-1097
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F05251036
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License Number State | TX
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