MEDICARE: HANNAH RUCKNER

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	208100000X	Physical Medicine & Rehabilitation Physician	40742	FL

General Provider Information

NPI Number	:	1942056510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH RUCKNER

Provider Business Mailing Address
First Line	:	6417 E COUNTY LINE RD STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6417 E COUNTY LINE RD STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1855
Country	:	US
Telephone Number	:	813-461-8840
Fax Number	:

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

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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Directions to “ HANNAH RUCKNER ” Practice Location

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