Provider Demographics
NPI:1376074823
Name:HANSON, JOSHUA (DOM)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W MLK BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 W MLK BLVD
Practice Address - Street 2:STE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3134
Practice Address - Country:US
Practice Address - Phone:813-534-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist