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General NPI Number Information
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NPI Number | 1508529637
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Entity Type | Individual
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Provider Name | DANA MARIE HARTLEY RD LD/N
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Gender | Female
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 3000 MEDICAL PARK DR STE 490
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City | TAMPA
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State | FL
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Zip | 33613-6600
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Country | US
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Telephone | 813-971-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 824 HAWK LNDG
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-6535
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Country | US
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Telephone | 305-481-1745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 4847
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License Number State | FL
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