Provider Demographics
NPI:1700879798
Name:HAFFNER, THERESA ROSE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ROSE
Last Name:HAFFNER
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 1:5422 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3948
Mailing Address - Country:US
Mailing Address - Phone:727-848-1096
Mailing Address - Fax:727-848-6367
Practice Address - Street 1:7575 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-6716
Practice Address - Country:US
Practice Address - Phone:727-861-9800
Practice Address - Fax:727-245-1390
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2153432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305407100Medicaid