Provider Demographics
NPI:1013382712
Name:HAUGE, JACLYN GOSSMAN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:GOSSMAN
Last Name:HAUGE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:DIANE
Other - Last Name:GOSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2593 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8808
Mailing Address - Country:US
Mailing Address - Phone:407-620-2662
Mailing Address - Fax:407-264-8508
Practice Address - Street 1:2593 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8808
Practice Address - Country:US
Practice Address - Phone:407-620-2662
Practice Address - Fax:407-264-8508
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW319176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife