Provider Demographics
NPI:1801632328
Name:HASLAM, AMBER KRISTINA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTINA MARIE
Last Name:HASLAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:KRISTINA MARIE
Other - Last Name:GITTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3424 TRAPNELL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33567-2070
Mailing Address - Country:US
Mailing Address - Phone:813-841-5540
Mailing Address - Fax:
Practice Address - Street 1:3424 TRAPNELL RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-2070
Practice Address - Country:US
Practice Address - Phone:813-841-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032014363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics