Provider Demographics
NPI:1447676796
Name:HANNAH, JEFFREY DANIEL
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:HANNAH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:HANNAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3720 GATTIS SCHOOL RD STE 800
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4660
Mailing Address - Country:US
Mailing Address - Phone:737-222-5553
Mailing Address - Fax:
Practice Address - Street 1:3720 GATTIS SCHOOL RD STE 800
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4660
Practice Address - Country:US
Practice Address - Phone:737-222-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant