Provider Demographics
NPI:1508130071
Name:HANSCOM, LANA (ARNP-C)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HANSCOM
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 LEWELLYN ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-0789
Mailing Address - Country:US
Mailing Address - Phone:863-581-6811
Mailing Address - Fax:
Practice Address - Street 1:5108 LEWELLYN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-0789
Practice Address - Country:US
Practice Address - Phone:863-581-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2621092363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health