Provider Demographics
NPI:1497140768
Name:HAUGEN, JENNIFER (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2808
Mailing Address - Country:US
Mailing Address - Phone:850-494-4600
Mailing Address - Fax:850-983-4025
Practice Address - Street 1:4244 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-2808
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:850-983-4025
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9229533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014757700Medicaid