MEDICARE: HAYLEY V PEINE

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	104100000X	Social Worker	12555	KS

General Provider Information

NPI Number	:	1528771912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY V PEINE

Provider Business Mailing Address
First Line	:	2662 N MCMULLEN BOOTH RD APT 426
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-4042
Country	:	US
Telephone Number	:	785-438-8280
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 BAY PINES BLVD
Second Line	:
City	:	BAY PINES
State	:	FL
Zip	:	33744-8200
Country	:	US
Telephone Number	:	727-391-6661
Fax Number	:

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

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	01/03/2023

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Directions to “ HAYLEY V PEINE ” Practice Location

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