Provider Demographics
NPI:1912287285
Name:HANCOCK, DEREK CAMPBELL (HAS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:CAMPBELL
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 N 9TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8280
Mailing Address - Country:US
Mailing Address - Phone:850-477-5935
Mailing Address - Fax:850-477-5936
Practice Address - Street 1:6024 N 9TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8280
Practice Address - Country:US
Practice Address - Phone:850-477-5935
Practice Address - Fax:850-477-5936
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 4783237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist