Provider Demographics
NPI:1174873731
Name:HYATT, JAMIE POWELL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:POWELL
Last Name:HYATT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15157 BANBURY WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8370
Mailing Address - Country:US
Mailing Address - Phone:205-305-6411
Mailing Address - Fax:
Practice Address - Street 1:15157 BANBURY WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8370
Practice Address - Country:US
Practice Address - Phone:205-305-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097478363LF0000X
FLARNP9398726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG186ZMedicare PIN