MEDICARE: MRS. NANCY HAAKE WALTER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11021956	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093438152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY HAAKE WALTER APRN

Provider Business Mailing Address
First Line	:	PO BOX 1200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-1200
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W SUNRISE BLVD STE 208
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5432
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	12/03/2025

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