Provider Demographics
NPI:1275931727
Name:HANSON, SVETLANA
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:HANSON
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 1:1012 AIRPORT RD UNIT 4B
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2898
Mailing Address - Country:US
Mailing Address - Phone:850-499-6687
Mailing Address - Fax:850-373-4910
Practice Address - Street 1:1012 AIRPORT RD UNIT 4B
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2898
Practice Address - Country:US
Practice Address - Phone:850-499-6687
Practice Address - Fax:850-373-4910
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207750207R00000X
FLME134303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNIOther1575931727