Provider Demographics
NPI:1871518381
Name:CLEMENTS, HANA J (MD)
Entity type:Individual
Prefix:DR
First Name:HANA
Middle Name:J
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-687-9333
Mailing Address - Fax:863-686-0160
Practice Address - Street 1:1629 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-687-9333
Practice Address - Fax:863-686-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035623207R00000X
FLME93473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110006311Medicaid
FL002742600Medicaid
FLDI595ZOtherMEDICARE ID TYPE UNSPECIFIED
FLG63826Medicare UPIN
FL002742600Medicaid
CT110006311Medicaid