Provider Demographics
NPI:1053884551
Name:HASAN, ALINA M
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:M
Last Name:HASAN
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 1:19828 MORDEN BLUSH DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9093
Mailing Address - Country:US
Mailing Address - Phone:813-335-3038
Mailing Address - Fax:
Practice Address - Street 1:92 CYPRESS BLVD W
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-4562
Practice Address - Country:US
Practice Address - Phone:352-765-4737
Practice Address - Fax:352-503-6868
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPA9114427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program