Provider Demographics
NPI:1801339940
Name:WOLDEYES, HANNA
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:WOLDEYES
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 1:1183 SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5916
Mailing Address - Country:US
Mailing Address - Phone:813-997-2397
Mailing Address - Fax:
Practice Address - Street 1:1183 SUWANEE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5916
Practice Address - Country:US
Practice Address - Phone:813-997-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9365072163W00000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376G00000XNursing Service Related ProvidersNursing Home Administrator