=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386717155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN M HAFNER P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 FOREST HILL BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-357-5636
-----------------------------------------------------
Fax | 561-357-7452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7784 GREAT OAK DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-7109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-357-5636
-----------------------------------------------------
Fax | 561-357-7452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9102793
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------