Provider Demographics
NPI:1891553251
Name:RAISTRICK, HANNAH JOY
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JOY
Last Name:RAISTRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 2ND AVE W APT A
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-7516
Mailing Address - Country:US
Mailing Address - Phone:309-838-7693
Mailing Address - Fax:
Practice Address - Street 1:825 4TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5013
Practice Address - Country:US
Practice Address - Phone:309-838-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist