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General NPI Number Information
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NPI Number | 1376871764
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Entity Type | Individual
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Provider Name | KEELEY HAAS NP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 807 S ORLANDO AVE SUITE C
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City | WINTER PARK
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State | FL
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Zip | 32789-4870
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Country | US
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Telephone | 407-515-2211
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Fax | 407-309-5412
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Provider Business Mailing Address
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Address Line | 807 S ORLANDO AVE SUITE C
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City | WINTER PARK
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State | FL
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Zip | 32789-4870
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Country | US
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Telephone | 407-515-2211
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Fax | 407-309-5412
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9217704
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License Number State | FL
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