Provider Demographics
NPI:1740931302
Name:JAHNA, WALTER MASON (APRN)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:MASON
Last Name:JAHNA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 ENTRANCE RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9105
Mailing Address - Country:US
Mailing Address - Phone:863-443-6329
Mailing Address - Fax:
Practice Address - Street 1:4409 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2170
Practice Address - Country:US
Practice Address - Phone:863-402-3480
Practice Address - Fax:863-402-3483
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily