Healthcare Provider Details

I. General information

NPI: 1467294496
Provider Name (Legal Business Name): JERICA S HARTFORD MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE STE G100
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3000 NEW BERN AVE STE G100
RALEIGH NC
27610-1231
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-6132
  • Fax:
Mailing address:
  • Phone: 919-231-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number335816
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5024776
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5024776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: