Provider Demographics
NPI:1467097642
Name:JOHNSON-HANNA, SHERRYL LYNN (MED RDN LDN)
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:LYNN
Last Name:JOHNSON-HANNA
Suffix:
Gender:F
Credentials:MED RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273538
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-3538
Mailing Address - Country:US
Mailing Address - Phone:813-545-0004
Mailing Address - Fax:813-443-1491
Practice Address - Street 1:4904 RAMBLING ROSE PLACE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624
Practice Address - Country:US
Practice Address - Phone:813-545-0004
Practice Address - Fax:813-443-1491
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered