Provider Demographics
NPI:1417130998
Name:HAAS, CHARLOTTE G (AP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:G
Last Name:HAAS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7018
Mailing Address - Country:US
Mailing Address - Phone:386-423-7898
Mailing Address - Fax:
Practice Address - Street 1:122 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7018
Practice Address - Country:US
Practice Address - Phone:386-423-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1667OtherLICENSE