MEDICARE: JENNIFER B HARTMAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209003287	IL
2	363LP0200X	Pediatric Nurse Practitioner	APRN11026698	FL

General Provider Information

NPI Number	:	1295729887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER B HARTMAN CRNP

Provider Business Mailing Address
First Line	:	632 DEL PRADO BLVD N STE 301
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2278
Country	:	US
Telephone Number	:	239-768-2111
Fax Number	:	239-482-4404

Provider Business Practice Location Address
First Line	:	632 DEL PRADO BLVD N STE 301
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2278
Country	:	US
Telephone Number	:	239-768-2111
Fax Number	:	239-482-4404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	10/09/2023

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