Provider Demographics
NPI:1164610077
Name:HAUGER, PHILIPPA J (CNM)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:J
Last Name:HAUGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:PHILIPPA
Other - Middle Name:J
Other - Last Name:NICKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E-170
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-770-6116
Practice Address - Fax:772-564-6120
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1942062367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS76074Medicare UPIN