Individual
ELEONORA HACKMAN-KERBYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2450 TAMIAMI TRL, STE A, PORT CHARLOTTE, FL 33952-3922
(941) 624-2704
(941) 627-6066
Mailing address
3434 HANCOCK BRIDGE PKWY, STE 301, N FORT MYERS, FL 33903-7094
(877) 856-3774
(239) 599-2625
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-110911
IL
207P00000X
Emergency Medicine Physician
2003014738
MO
207R00000X
Internal Medicine Physician
Primary
ME104987
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110911
—
IL
01
—
124884
BLUE CROSS
MO
05
—
208440818
—
MO
01
—
426403
HEALTHLINK
MO
01
—
947071631
MERCY HEALTH
MO
01
—
P00145175
RAILROAD MEDICARE
MO
Enumeration date
06/12/2006
Last updated
02/20/2014
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