Provider Demographics
NPI:1265981476
Name:VON HAVEN, HALEY NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:NICOLE
Last Name:VON HAVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-479-3320
Mailing Address - Fax:850-479-8789
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 309
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:850-479-3320
Practice Address - Fax:850-479-8789
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9110516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant