Provider Demographics
NPI:1053473678
Name:BAIR, HANNAH GRACE (PA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:BAIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-5011
Mailing Address - Country:US
Mailing Address - Phone:863-494-6222
Mailing Address - Fax:863-494-3227
Practice Address - Street 1:1110 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-5011
Practice Address - Country:US
Practice Address - Phone:863-494-6222
Practice Address - Fax:863-494-3227
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical