Provider Demographics
NPI:1801863154
Name:HARE, NINA M (DO)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:HARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 SE LAKE WEIR AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6720
Mailing Address - Country:US
Mailing Address - Phone:352-620-2200
Mailing Address - Fax:352-620-8384
Practice Address - Street 1:2631 SE LAKE WEIR AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6720
Practice Address - Country:US
Practice Address - Phone:352-620-2200
Practice Address - Fax:352-620-8384
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061794600Medicaid
FL061794600Medicaid
FL80278Medicare PIN