MEDICARE: MRS. JENNIFER A HANLEY PA-C

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	363AS0400X	Surgical Physician Assistant	PA9100969	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9287537	OTHER	FL	AETNA PIN
2	Y04UH	OTHER	FL	FLORIDA BLUE BCBS#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477502391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER A HANLEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-254-7717
Fax Number	:	321-255-2361

Provider Business Practice Location Address
First Line	:	2200 W EAU GALLIE BLVD STE 202B
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3166
Country	:	US
Telephone Number	:	321-254-7717
Fax Number	:	321-255-2361

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/24/2021

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Directions to “ MRS. JENNIFER A HANLEY PA-C” Practice Location

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