Provider Demographics
NPI:1093594004
Name:HAMANN, CHAD P
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:P
Last Name:HAMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9629
Mailing Address - Country:US
Mailing Address - Phone:772-480-5860
Mailing Address - Fax:
Practice Address - Street 1:5075 INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6101
Practice Address - Country:US
Practice Address - Phone:561-935-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028872363LP2300X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty