Provider Demographics
NPI:1639470370
Name:HANNA, CHRISTINE E (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:HANNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 UNIVERSITY BLVD S
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-636-9100
Mailing Address - Fax:904-636-9102
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:STE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-636-9100
Practice Address - Fax:904-636-9102
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLEH505XMedicare PIN