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General NPI Number Information
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NPI Number | 1629386248
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Entity Type | Individual
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Provider Name | PAULINE L HAFER PA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1840 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-4716
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Country | US
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Telephone | 321-360-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 58TH AVE STE 110
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City | VERO BEACH
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State | FL
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Zip | 32966-4675
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Country | US
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Telephone | 772-257-3200
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111508
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License Number State | FL
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