Provider Demographics
NPI:1124729009
Name:STEPHENS, HALEY (RN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
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 16011
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 MANDALAY AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-1242
Practice Address - Country:US
Practice Address - Phone:727-463-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1146722251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health