Individual
HANNAH FORDRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2100 STATE AVE, PANAMA CITY, FL 32405-4587
(850) 763-0036
Mailing address
2100 STATE AVE, PANAMA CITY, FL 32405-4587
(850) 763-0036
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
4603
CO
363AM0700X
Medical Physician Assistant
Primary
9115156
FL
363AM0700X
Medical Physician Assistant
MA057844
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113338100
—
FL
05
—
32130261
—
CO
Enumeration date
09/16/2015
Last updated
02/27/2023
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