Provider Demographics
NPI:1265299812
Name:HENNESSY, SABRINA LYNN HALL (LM, CPM)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:LYNN HALL
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:LYNN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2217 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9521
Mailing Address - Country:US
Mailing Address - Phone:239-293-5387
Mailing Address - Fax:
Practice Address - Street 1:2217 CANAL ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9521
Practice Address - Country:US
Practice Address - Phone:239-293-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
FLM470176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay