Provider Demographics
NPI:1700199221
Name:NOSSHEY F HANNA MD PA
Entity Type:Organization
Organization Name:NOSSHEY F HANNA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NOSSHEY
Authorized Official - Middle Name:FAWZI
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-268-8460
Mailing Address - Street 1:4010 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6026
Mailing Address - Country:US
Mailing Address - Phone:904-268-8460
Mailing Address - Fax:904-268-9809
Practice Address - Street 1:4010 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6026
Practice Address - Country:US
Practice Address - Phone:904-268-8460
Practice Address - Fax:904-268-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043781207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10990OtherBCBS-MCR PROVIDER #
FL10990Medicare PIN
FLE-59532Medicare UPIN