Healthcare Provider Details

I. General information

NPI: 1043473283
Provider Name (Legal Business Name): JAMES A HALEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S PARSONS AVE APT#1014
BRANDON FL
33511-6069
US

IV. Provider business mailing address

529 S PARSONS AVE APT#1014
BRANDON FL
33511-6069
US

V. Phone/Fax

Practice location:
  • Phone: 813-300-3098
  • Fax:
Mailing address:
  • Phone: 813-300-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberPN5181692
License Number StateFL

VIII. Authorized Official

Name: MRS. RACHELL JEANETTE FLORES
Title or Position: LICSENCED PRACTICAL NURSE
Credential: LPN
Phone: 813-300-3098