1174070304 NPI number — NANCY MAY HATCH

Table of content: NANCY MAY HATCH (NPI 1174070304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174070304 NPI number — NANCY MAY HATCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATCH
Provider First Name:
NANCY
Provider Middle Name:
MAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174070304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6330 99TH WAY N
Provider Second Line Business Mailing Address:
UNIT 14-D
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33708-4534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-518-2990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4707 W GANDY BLVD
Provider Second Line Business Practice Location Address:
SUITE 12B
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33611-3372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-380-8230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SI2922 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)