Provider Demographics
NPI:1114571411
Name:HATER, SONYA (APRN)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:HATER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:DINDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 S BUNGALOW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3113
Mailing Address - Country:US
Mailing Address - Phone:802-522-8912
Mailing Address - Fax:
Practice Address - Street 1:208 S BUNGALOW PARK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3113
Practice Address - Country:US
Practice Address - Phone:802-522-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002977363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11002977OtherMEDICAL LICENSE