Provider Demographics
NPI:1093177842
Name:HAMPSHIRE, MARISA (CNA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:HAMPSHIRE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16011
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6011
Mailing Address - Country:US
Mailing Address - Phone:727-307-0345
Mailing Address - Fax:727-674-2932
Practice Address - Street 1:4374 RIDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1165
Practice Address - Country:US
Practice Address - Phone:727-307-0345
Practice Address - Fax:727-674-2932
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL266958251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health