Healthcare Provider Details

I. General information

NPI: 1790730794
Provider Name (Legal Business Name): DIANE HUBERTZ HAUGE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE HUBERTZ ARNP

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE OSCEOLA ST SUITE 100
STUART FL
34994-2364
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1550
  • Fax: 772-221-0569
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2999642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: