Provider Demographics
NPI:1104385459
Name:HANCOCK, DEMICIA DAWN
Entity Type:Individual
Prefix:
First Name:DEMICIA
Middle Name:DAWN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WINDWOOD OAKS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1956
Mailing Address - Country:US
Mailing Address - Phone:813-526-3855
Mailing Address - Fax:
Practice Address - Street 1:252 WINDWOOD OAKS DR APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1956
Practice Address - Country:US
Practice Address - Phone:813-526-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider