Provider Demographics
NPI:1225221070
Name:HATTEN, VANERA GREENE
Entity Type:Individual
Prefix:MRS
First Name:VANERA
Middle Name:GREENE
Last Name:HATTEN
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 1:12131 CANCUN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4687
Mailing Address - Country:US
Mailing Address - Phone:904-477-3843
Mailing Address - Fax:904-998-1404
Practice Address - Street 1:12131 CANCUN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4687
Practice Address - Country:US
Practice Address - Phone:904-477-3843
Practice Address - Fax:904-998-1404
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229997171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225221070Medicaid