Individual
HALEY C MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2902 59TH ST W STE C, BRADENTON, FL 34209-7021
(941) 877-7000
(941) 242-1440
Mailing address
2902 59TH ST W STE C, BRADENTON, FL 34209-7021
(941) 877-7000
(941) 242-1440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PA9113981
FL
363A00000X
Physician Assistant
Primary
PA9113981
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9113981
PA LICENCE
FL
Enumeration date
01/21/2021
Last updated
05/20/2022
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