Provider Demographics
NPI:1902546609
Name:CROTTY, HANNAH LACY (DO)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LACY
Last Name:CROTTY
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 1:3100 E FLETCHER AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4613
Mailing Address - Country:US
Mailing Address - Phone:813-467-4770
Mailing Address - Fax:813-467-4243
Practice Address - Street 1:3100 E FLETCHER AVE STE 126
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-467-4770
Practice Address - Fax:813-467-4243
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS22117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics