Healthcare Provider Details

I. General information

NPI: 1932822079
Provider Name (Legal Business Name): HALEY WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 PARK ST STE 300
SEMINOLE FL
33777-4632
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 321-343-6833
  • Fax:
Mailing address:
  • Phone:
  • Fax: 639-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: