Basic Information
Provider Information
NPI: 1730773128
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAQ
FirstName: NOREEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6636 SW 81ST TER
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326085630
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1601 SW ARCHER RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326081135
CountryCode: US
TelephoneNumber: 3525486000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2021
LastUpdateDate: 02/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11011003FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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