=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700199221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOSSHEY F HANNA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 SUNBEAM RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-6026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-268-8460
-----------------------------------------------------
Fax | 904-268-9809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4010 SUNBEAM RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-6026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-268-8460
-----------------------------------------------------
Fax | 904-268-9809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR/PHYSICIAN
-----------------------------------------------------
Name | NOSSHEY FAWZI HANNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 904-268-8460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0043781
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME0043781
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------