Provider Demographics
NPI:1033872767
Name:HAAS, TIA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:HAAS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 DAVIS BLVD STE 402
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3438
Practice Address - Country:US
Practice Address - Phone:813-821-8008
Practice Address - Fax:813-821-8355
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016094363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112562300Medicaid
FL9SX3GOtherBLUE CROSS BLUE SHIELD