Provider Demographics
NPI:1588354401
Name:HANNAGAN, MARK H
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:HANNAGAN
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 1:7018 W BEDFORDSHIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-7809
Mailing Address - Country:US
Mailing Address - Phone:575-446-8035
Mailing Address - Fax:157-520-1765
Practice Address - Street 1:7018 W BEDFORDSHIRE LOOP
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-7809
Practice Address - Country:US
Practice Address - Phone:575-446-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services