MEDICARE: DEENA R. HACKETT A.P.

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	171100000X	Acupuncturist	AP2078	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP2078	OTHER	FL	ACUPUNCTURE PHYSICIAN

General Provider Information

NPI Number	:	1962451575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENA R. HACKETT A.P.

Provider Business Mailing Address
First Line	:	4921 RINGWOOD MDWS
Second Line	:	BLDG A
City	:	SARASOTA
State	:	FL
Zip	:	34235-2033
Country	:	US
Telephone Number	:	941-321-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 RINGWOOD MDWS
Second Line	:	BLDG A
City	:	SARASOTA
State	:	FL
Zip	:	34235-2033
Country	:	US
Telephone Number	:	941-321-7625
Fax Number	:

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	10/20/2011

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