Provider Demographics
NPI:1225128572
Name:HANSON, LENITA (MD)
Entity Type:Individual
Prefix:
First Name:LENITA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21216 OLEAN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6722
Mailing Address - Country:US
Mailing Address - Phone:941-624-4800
Mailing Address - Fax:941-206-0048
Practice Address - Street 1:21216 OLEAN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6722
Practice Address - Country:US
Practice Address - Phone:941-624-4800
Practice Address - Fax:941-206-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067817207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26625YMedicare ID - Type Unspecified
FLE94710Medicare UPIN