Provider Demographics
NPI:1578808986
Name:DE HAAN, JESSICA LAUREN ROBERTS (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN ROBERTS
Last Name:DE HAAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5708
Mailing Address - Country:US
Mailing Address - Phone:850-416-2400
Mailing Address - Fax:850-416-2330
Practice Address - Street 1:1657 TRINITY DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5708
Practice Address - Country:US
Practice Address - Phone:850-416-2400
Practice Address - Fax:850-416-2330
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN37934207V00000X, 207V00000X
ALPA-841363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical