1053884551 NPI number — ALINA M HASAN

Table of content: ALINA M HASAN (NPI 1053884551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053884551 NPI number — ALINA M HASAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASAN
Provider First Name:
ALINA
Provider Middle Name:
M
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:
1053884551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19828 MORDEN BLUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33558-9093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-335-3038
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 CYPRESS BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMOSASSA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34446-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-765-4737
Provider Business Practice Location Address Fax Number:
352-503-6868
Provider Enumeration Date:
01/07/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA9114427 , 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)

  • Identifier: 113783000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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