Provider Demographics
NPI:1619550910
Name:VOLANTE, HALEY EMMA (IDC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:EMMA
Last Name:VOLANTE
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS ST LOUIS (LCS-19)
Mailing Address - Street 2:#100524 BOX 001
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34089
Mailing Address - Country:US
Mailing Address - Phone:904-314-4549
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228-2065
Practice Address - Country:US
Practice Address - Phone:413-388-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman