MEDICARE: DEANNA S HANSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1467933457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA S HANSELL

Provider Business Mailing Address
First Line	:	2822 SUNNYSIDE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-4358
Country	:	US
Telephone Number	:	904-862-5855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 SUNNYSIDE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-4358
Country	:	US
Telephone Number	:	904-862-5855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	03/12/2026

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