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NPI Code Detail

MEDICARE: HALEY ELIZABETH ANDERSON PA-C, ATC

MEDICARE: HALEY ELIZABETH ANDERSON PA-C, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer
2363A00000XPhysician Assistant9117956FL

General Provider Information

NPI Number : 1134504665
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY ELIZABETH ANDERSON PA-C, ATC
Provider Business Mailing Address
First Line : 6675 CORPORATE CENTER PKWY STE 115
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8088
Country : US
Telephone Number : 609-709-3691
Fax Number :
Provider Business Practice Location Address
First Line : 6675 CORPORATE CENTER PKWY STE 115
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8088
Country : US
Telephone Number : 609-709-3691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2015
Last Update Date : 10/02/2023

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