Healthcare Provider Details

I. General information

NPI: 1003480294
Provider Name (Legal Business Name): LAURA LEE HARTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD STE 309
BOCA RATON FL
33496-2661
US

IV. Provider business mailing address

1905 CLINT MOORE RD STE 309
BOCA RATON FL
33496-2661
US

V. Phone/Fax

Practice location:
  • Phone: 561-988-8988
  • Fax: 561-912-1804
Mailing address:
  • Phone: 561-988-8988
  • Fax: 561-912-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: