Provider Demographics
NPI:1558824292
Name:HUFFAKER, JOHN (ARNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4910
Mailing Address - Country:US
Mailing Address - Phone:330-354-9550
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 307
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2428
Practice Address - Country:US
Practice Address - Phone:941-786-4066
Practice Address - Fax:941-761-6708
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily