Provider Demographics
NPI:1235173113
Name:HANSON, CARRIE B (CNM)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TAMPA GENERAL CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3578
Mailing Address - Country:US
Mailing Address - Phone:813-258-3309
Mailing Address - Fax:813-251-4454
Practice Address - Street 1:5002 W LEMON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1104
Practice Address - Country:US
Practice Address - Phone:813-286-0033
Practice Address - Fax:813-286-1806
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9468583367A00000X
FLARNP9468583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJH746YOtherMEDICARE
FL103669300Medicaid
Q10990Medicare UPIN