Provider Demographics
NPI:1982024006
Name:HAYGOOD, JEANNAN
Entity Type:Individual
Prefix:
First Name:JEANNAN
Middle Name:
Last Name:HAYGOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16131
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687
Mailing Address - Country:US
Mailing Address - Phone:813-966-3030
Mailing Address - Fax:
Practice Address - Street 1:8911 REGENTS PARK DR
Practice Address - Street 2:STE 510
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3420
Practice Address - Country:US
Practice Address - Phone:813-966-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical