Provider Demographics
NPI:1457027211
Name:PETRENKO, HANNAH LYNN (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LYNN
Last Name:PETRENKO
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N HALL ST APT 176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3955
Mailing Address - Country:US
Mailing Address - Phone:714-357-6930
Mailing Address - Fax:
Practice Address - Street 1:5700 GRANITE PKWY STE 370
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6625
Practice Address - Country:US
Practice Address - Phone:888-874-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner