Provider Demographics
NPI:1083136881
Name:SAMIR K. HANNA & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SAMIR K. HANNA & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-384-5571
Mailing Address - Street 1:5435 ORTEGA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8435
Mailing Address - Country:US
Mailing Address - Phone:904-384-5571
Mailing Address - Fax:904-384-0877
Practice Address - Street 1:5435 ORTEGA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8435
Practice Address - Country:US
Practice Address - Phone:904-384-5571
Practice Address - Fax:904-384-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental