Provider Demographics
NPI:1508169699
Name:HANNAN, GLENDA (ARNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:HANNAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:
Other - Last Name:MACIEL-HANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-6720
Mailing Address - Country:US
Mailing Address - Phone:954-913-8755
Mailing Address - Fax:
Practice Address - Street 1:112 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-6720
Practice Address - Country:US
Practice Address - Phone:954-913-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARN9275654363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health