Healthcare Provider Details

I. General information

NPI: 1538099122
Provider Name (Legal Business Name): MATTHEW HARTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 NW 13TH ST
GAINESVILLE FL
32601-5698
US

IV. Provider business mailing address

203 NW 13TH ST
GAINESVILLE FL
32601-5698
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-7474
  • Fax: 352-260-0811
Mailing address:
  • Phone: 352-339-7474
  • Fax: 352-260-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: