Healthcare Provider Details

I. General information

NPI: 1447115076
Provider Name (Legal Business Name): DERRICK VAN HAILE II APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

24927 NW 202ND LN
HIGH SPRINGS FL
32643-7241
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN9484004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: