Provider Demographics
NPI:1194942326
Name:HATFIELD, HOWARD KEITH (PA-C)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:KEITH
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 RIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5317
Mailing Address - Country:US
Mailing Address - Phone:850-877-4134
Mailing Address - Fax:850-402-9130
Practice Address - Street 1:1707 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5317
Practice Address - Country:US
Practice Address - Phone:850-877-4134
Practice Address - Fax:850-402-9130
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ03137Medicare UPIN
FLU1676ZMedicare ID - Type UnspecifiedMEDICARE