Healthcare Provider Details

I. General information

NPI: 1700879798
Provider Name (Legal Business Name): THERESA ROSE HAFFNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 STATE ROAD 52
BAYONET POINT FL
34667-6716
US

IV. Provider business mailing address

5422 US HIGHWAY 19
NEW PORT RICHEY FL
34652-3948
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-9800
  • Fax: 727-245-1390
Mailing address:
  • Phone: 727-848-1096
  • Fax: 727-848-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2153432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: