Provider Demographics
NPI:1629487855
Name:HASELDEN, PATRICIA A (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:HASELDEN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:912-629-7800
Mailing Address - Fax:912-355-5515
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:STE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-629-7800
Practice Address - Fax:912-355-5515
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183193JMedicaid
GA003183193KMedicaid
GA003183193AMedicaid