Healthcare Provider Details

I. General information

NPI: 1598698813
Provider Name (Legal Business Name): JUSTIN GARRETT HARTMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEMORIAL PKWY
DAYTONA BEACH FL
32117
US

IV. Provider business mailing address

7 LYTTON LN
PALM COAST FL
32137-9514
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-6000
  • Fax:
Mailing address:
  • Phone: 404-345-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11048324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: