Provider Demographics
NPI:1750783593
Name:HANNA, JENNIFER (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W 2ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3775
Mailing Address - Country:US
Mailing Address - Phone:903-875-2188
Mailing Address - Fax:903-875-2186
Practice Address - Street 1:1321 W 2ND AVE STE B
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3775
Practice Address - Country:US
Practice Address - Phone:903-872-5321
Practice Address - Fax:903-875-2186
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily