Basic Information
| Provider Information | |||||||||
| NPI: | 1508218454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | SHERIDA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 864627 | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328864627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866714519 | ||||||||
| FaxNumber: | 3866729904 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 MEMORIAL MEDICAL PKWY | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321175168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862316000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2016 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0616958 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.