MEDICARE: CHARLOTTE G HAAS AP

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
1	171100000X	Acupuncturist	AP1667	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP1667	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1417130998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE G HAAS AP

Provider Business Mailing Address
First Line	:	122 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7018
Country	:	US
Telephone Number	:	386-423-7898
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7018
Country	:	US
Telephone Number	:	386-423-7898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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Directions to “ CHARLOTTE G HAAS AP” Practice Location

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