Provider Demographics
NPI:1245716836
Name:WHITTENBURG, HAYLIE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:HAYLIE
Middle Name:
Last Name:WHITTENBURG
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-751-4906
Mailing Address - Fax:904-714-3574
Practice Address - Street 1:280 DUNDAS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5517
Practice Address - Country:US
Practice Address - Phone:904-751-4906
Practice Address - Fax:904-714-3574
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9369686363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner