Healthcare Provider Details

I. General information

NPI: 1376094805
Provider Name (Legal Business Name): LAUREN HARTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 S SEACREST BLVD STE B
BOYNTON BEACH FL
33435-7534
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-3376
  • Fax: 561-737-5221
Mailing address:
  • Phone: 866-400-3376
  • Fax: 470-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00413100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: