Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW319 | FL |
NPI | 1013382712 |
---|---|
Provider Name | Jaclyn Gossman Hauge |
First Address | Deltona, FL 32738-8808 |
Second Address | Deltona, FL 32738-8808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2015 |
Last Update Date | 07/12/2015 |