MEDICARE: JAMES A HALEY VA

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	2865M2000X	Military General Acute Care Hospital	RT 3850	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2279C0205X	OTHER	FL	RRT

General Provider Information

NPI Number	:	1134290679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES A HALEY VA

Provider Business Mailing Address
First Line	:	22520 EAGLES WATCH DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-6773
Country	:	US
Telephone Number	:	813-469-1955
Fax Number	:

Provider Business Practice Location Address
First Line	:	13000 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-4745
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:

Authorized Official
Title or Position	:	RESP THERAPIST
Name	:	MR. ELLIOT ECHEVARRIA
Credential	:	RRT
Telephone Number	:	813-469-1955

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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