Healthcare Provider Details

I. General information

NPI: 1710316427
Provider Name (Legal Business Name): HESTER E. HARTMAN P. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2013
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD SUITE 1100
JACKSONVILLE FL
32216-5876
US

IV. Provider business mailing address

4205 BELFORT RD SUITE 1100
JACKSONVILLE FL
32216-5876
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3103
  • Fax: 904-296-3106
Mailing address:
  • Phone: 904-296-3103
  • Fax: 904-296-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: