Provider Demographics
NPI:1801893938
Name:HOCKENSMITH, BRIAN (ARNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HOCKENSMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:813-654-7005
Mailing Address - Fax:813-654-1050
Practice Address - Street 1:1944 SR 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:386-428-3241
Practice Address - Fax:844-295-1379
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9208291207Q00000X
MDR133985363LA2200X
FLAPRN9208291363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001463000Medicaid
5015E812Medicare PIN
P69699Medicare UPIN