Healthcare Provider Details

I. General information

NPI: 1376645465
Provider Name (Legal Business Name): JUDITH A HARTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 MICHIGAN AVE
FORT MYERS FL
33916-2205
US

IV. Provider business mailing address

3920 MICHIGAN AVE
FORT MYERS FL
33916-2205
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-9510
  • Fax: 239-332-9656
Mailing address:
  • Phone: 239-332-9510
  • Fax: 239-332-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberPHC12
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: