Basic Information
| Provider Information | |||||||||
| NPI: | 1932428869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAESEKER | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | |||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 NW 64TH TER | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523313583 | ||||||||
| FaxNumber: | 3523313669 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 NW 64TH TER | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523313583 | ||||||||
| FaxNumber: | 3523313669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2010 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP 9266802 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.