Healthcare Provider Details

I. General information

NPI: 1497140768
Provider Name (Legal Business Name): JENNIFER HAUGEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 AVALON BLVD
MILTON FL
32583-2808
US

IV. Provider business mailing address

4244 AVALON BLVD
MILTON FL
32583-2808
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-4600
  • Fax: 850-983-4025
Mailing address:
  • Phone: 850-494-4600
  • Fax: 850-983-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9229533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: