Healthcare Provider Details

I. General information

NPI: 1386229094
Provider Name (Legal Business Name): ABBY JO HYATT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 1ST ST N
WINTER HAVEN FL
33881-4111
US

IV. Provider business mailing address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3094
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1191
  • Fax:
Mailing address:
  • Phone: 863-293-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: