Individual
MR. JACKIE DALE HATTEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
500 N WEST SHORE BLVD STE 635, TAMPA, FL 33609-1910
(813) 513-9493
(904) 562-3317
Mailing address
500 N WEST SHORE BLVD STE 635, TAMPA, FL 33609-1910
(813) 513-9493
(904) 562-3317
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP3419772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639607732
EMPLOYER DOSE NOT TAKE INSURANCE
FL
Enumeration date
06/01/2017
Last updated
10/04/2018
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