Provider Demographics
NPI:1467426338
Name:HANKS, DEANNA R (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:R
Last Name:HANKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20866 WHEELOCK DR
Mailing Address - Street 2:
Mailing Address - City:N FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-7785
Mailing Address - Country:US
Mailing Address - Phone:239-543-3969
Mailing Address - Fax:239-543-3969
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:STE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9335
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1932232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P0015297OtherRAILROAD MEDICARE
FLG2017OtherBC/BS FL
FL301689700Medicaid
FLG2017OtherBC/BS FL