Provider Demographics
NPI:1508677154
Name:HANN, AUTUMN ROSE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:ROSE
Last Name:HANN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CYPRESS TREE LOOP
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-6768
Mailing Address - Country:US
Mailing Address - Phone:845-249-5303
Mailing Address - Fax:
Practice Address - Street 1:9547 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4039
Practice Address - Country:US
Practice Address - Phone:843-429-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29860363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health