Healthcare Provider Details

I. General information

NPI: 1417293762
Provider Name (Legal Business Name): JANE A HARTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 A1A BEACH BLVD SUITE 3
SAINT AUGUSTINE FL
32080-6776
US

IV. Provider business mailing address

890 A1A BEACH BLVD SUITE 3
SAINT AUGUSTINE FL
32080-6776
US

V. Phone/Fax

Practice location:
  • Phone: 319-269-3824
  • Fax:
Mailing address:
  • Phone: 319-269-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00273
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: