Provider Demographics
NPI:1497485213
Name:HANLEY, NJOKI
Entity Type:Individual
Prefix:
First Name:NJOKI
Middle Name:
Last Name:HANLEY
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 1:1070 MONTGOMERY RD # 684
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7420
Mailing Address - Country:US
Mailing Address - Phone:407-848-0340
Mailing Address - Fax:
Practice Address - Street 1:11274 W HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9762
Practice Address - Country:US
Practice Address - Phone:407-848-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5245730164W00000X
ZZRN724163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0
FL0Other0