Provider Demographics
NPI:1194778852
Name:HANFLINK, NATHAN J (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:HANFLINK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6148
Mailing Address - Country:US
Mailing Address - Phone:352-357-0668
Mailing Address - Fax:352-357-3643
Practice Address - Street 1:601 JENNINGS AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6148
Practice Address - Country:US
Practice Address - Phone:352-357-0668
Practice Address - Fax:352-357-3642
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-04-21
Deactivation Date:2017-11-13
Deactivation Code:
Reactivation Date:2017-11-29
Provider Licenses
StateLicense IDTaxonomies
FLOS9725208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11551057OtherCAQH PROVIDER
FL663004001Medicaid
FL11551057OtherCAQH PROVIDER