Healthcare Provider Details

I. General information

NPI: 1366335192
Provider Name (Legal Business Name): MARISA ROSE HARTNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ALTAIR PKWY STE 3100
WESTERVILLE OH
43082-7653
US

IV. Provider business mailing address

400 ALTAIR PKWY STE 3100
WESTERVILLE OH
43082-7653
US

V. Phone/Fax

Practice location:
  • Phone: 614-360-9995
  • Fax: 844-571-1777
Mailing address:
  • Phone: 614-360-9995
  • Fax: 844-571-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTMP-163788
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11037938
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041771
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025459
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4063615
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: