Provider Demographics
NPI:1497426894
Name:DEEGAN, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:DEEGAN
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 1:638 TIMBER POND DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4354
Mailing Address - Country:US
Mailing Address - Phone:904-226-6024
Mailing Address - Fax:
Practice Address - Street 1:638 TIMBER POND DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-4354
Practice Address - Country:US
Practice Address - Phone:904-226-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant