Provider Demographics
NPI:1548969009
Name:HAUGHEY, JENNIFER ELLEN (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:HAUGHEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENN
Other - Middle Name:ELLEN
Other - Last Name:HAUGHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:5205 OAKLINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4034
Mailing Address - Country:US
Mailing Address - Phone:619-244-0486
Mailing Address - Fax:
Practice Address - Street 1:11948 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6601
Practice Address - Country:US
Practice Address - Phone:619-244-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily