Provider Demographics
NPI:1083431027
Name:HUNTER, TRAVONNA M
Entity type:Individual
Prefix:
First Name:TRAVONNA
Middle Name:M
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2766
Mailing Address - Country:US
Mailing Address - Phone:904-803-3805
Mailing Address - Fax:
Practice Address - Street 1:2155 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2766
Practice Address - Country:US
Practice Address - Phone:904-803-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QC1500X
342000000X, 1744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No342000000XTransportation ServicesTransportation Network Company