Healthcare Provider Details

I. General information

NPI: 1295709368
Provider Name (Legal Business Name): DONNA MARIE HARTWIGER CST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DONNA JONES, VEARY, MACHOLD

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N PARKWAY FRONTAGE RD
LAKELAND FL
33803
US

IV. Provider business mailing address

PO BOX 95004
LAKELAND FL
33804
US

V. Phone/Fax

Practice location:
  • Phone: 863-647-8011
  • Fax: 863-647-8029
Mailing address:
  • Phone: 863-680-7206
  • Fax: 863-680-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberPN589231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: