Provider Demographics
NPI:1093438152
Name:WALTER, NANCY HAAKE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:HAAKE
Last Name:WALTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 VIRGINIA LEE CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-6254
Mailing Address - Country:US
Mailing Address - Phone:813-842-7938
Mailing Address - Fax:
Practice Address - Street 1:1851 VIRGINIA LEE CIR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-6254
Practice Address - Country:US
Practice Address - Phone:813-842-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021956363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care