Basic Information
| Provider Information | |||||||||
| NPI: | 1992844963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAND | ||||||||
| FirstName: | MARY ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11728 DERBYSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336262639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138544069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7402 N 56TH ST | ||||||||
| Address2: | SUITE 906 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336177733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139887633 | ||||||||
| FaxNumber: | 8138140403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 2573512 | FL | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8112606 | 05 | FL | MEDICAID |