Provider Demographics
NPI:1396731881
Name:HALEY, ROSEMARY T (ARNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:T
Last Name:HALEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NURSING HOME DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3839
Mailing Address - Country:US
Mailing Address - Phone:863-491-8889
Mailing Address - Fax:863-494-0759
Practice Address - Street 1:1540 S TAMIAMI TRL STE 401
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2921
Practice Address - Country:US
Practice Address - Phone:941-917-0060
Practice Address - Fax:941-552-0316
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1697822363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303027000Medicaid
FL500017976OtherMEDICARE RR
FL303027000Medicaid
FLD64648Medicare UPIN