Provider Demographics
NPI:1659864767
Name:BANKS, HAILEE (MD)
Entity Type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAILEE
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4219
Mailing Address - Country:US
Mailing Address - Phone:523-335-2423
Mailing Address - Fax:
Practice Address - Street 1:447 N STATE ROAD 21
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-4172
Practice Address - Country:US
Practice Address - Phone:786-338-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN27098207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine