Healthcare Provider Details

I. General information

NPI: 1558824292
Provider Name (Legal Business Name): JOHN HUFFAKER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TAMIAMI TRL S STE 307
VENICE FL
34285-2428
US

IV. Provider business mailing address

3105 SW 18TH AVE
CAPE CORAL FL
33914-4910
US

V. Phone/Fax

Practice location:
  • Phone: 941-786-4066
  • Fax: 941-761-6708
Mailing address:
  • Phone: 330-354-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: