Healthcare Provider Details

I. General information

NPI: 1700021326
Provider Name (Legal Business Name): PATRICIA F. HARTZOG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A. FARRIS

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

IV. Provider business mailing address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-1450
  • Fax:
Mailing address:
  • Phone: 888-414-5120
  • Fax: 855-999-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-093197
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: