Provider Demographics
NPI:1770276057
Name:ZIMMERMAN, HALEY LOUISE (FNP-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LOUISE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:123 SANDY BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2453
Mailing Address - Country:US
Mailing Address - Phone:141-065-2545
Mailing Address - Fax:
Practice Address - Street 1:8109 RITCHIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6903
Practice Address - Country:US
Practice Address - Phone:443-270-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220155163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse