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General NPI Number Information
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NPI Number | 1093438152
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Entity Type | Individual
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Provider Name | NANCY HAAKE WALTER APRN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 8320 W SUNRISE BLVD STE 208
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City | PLANTATION
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State | FL
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Zip | 33322-5432
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-1200
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Country | US
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Telephone | 800-640-3451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11021956
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License Number State | FL
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