Provider Demographics
NPI:1891491577
Name:HASKINS, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HASKINS
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 1:3300 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1512
Mailing Address - Country:US
Mailing Address - Phone:321-269-6530
Mailing Address - Fax:
Practice Address - Street 1:5005 PORT ST JOHN PKWY STE 2400
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-877-2700
Practice Address - Fax:321-806-3059
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily