Provider Demographics
NPI:1962451575
Name:HACKETT, DEENA R (AP)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:R
Last Name:HACKETT
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 RINGWOOD MDWS
Mailing Address - Street 2:BLDG A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2033
Mailing Address - Country:US
Mailing Address - Phone:941-321-7625
Mailing Address - Fax:
Practice Address - Street 1:4921 RINGWOOD MDWS
Practice Address - Street 2:BLDG A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2033
Practice Address - Country:US
Practice Address - Phone:941-321-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2078OtherACUPUNCTURE PHYSICIAN