Basic Information
Provider Information
NPI: 1346718442
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEBSTER
FirstName: HANNAH
MiddleName: BETH
NamePrefix:  
NameSuffix:  
Credential: APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1005 MAR WALT DR
Address2:  
City: FORT WALTON BEACH
State: FL
PostalCode: 325476707
CountryCode: US
TelephoneNumber: 8502430118
FaxNumber: 8502430594
Practice Location
Address1: 1000 MAR WALT DR
Address2:  
City: FORT WALTON BEACH
State: FL
PostalCode: 325476708
CountryCode: US
TelephoneNumber: 8508621111
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/06/2018
LastUpdateDate: 11/06/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPRN9485333FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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