Provider Demographics
NPI:1891035663
Name:HERMANSEN, DAVID SEAN (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SEAN
Last Name:HERMANSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6418
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-247-0091
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6418
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:229-247-0091
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant