Provider Demographics
NPI:1417621822
Name:HUNTLEY, PHINON
Entity Type:Individual
Prefix:
First Name:PHINON
Middle Name:
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 BRADFORD HILL CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4873
Mailing Address - Country:US
Mailing Address - Phone:813-474-8540
Mailing Address - Fax:
Practice Address - Street 1:6445 BRADFORD HILL CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33545-4873
Practice Address - Country:US
Practice Address - Phone:813-474-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014748363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health