MEDICARE: MS. JENNESSA HART MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275901035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNESSA HART MSW

Provider Business Mailing Address
First Line	:	2121 LISENBY AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2910
Country	:	US
Telephone Number	:	850-763-7102
Fax Number	:

Provider Business Practice Location Address
First Line	:	7402 MCELVEY RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7606
Country	:	US
Telephone Number	:	850-249-0433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	09/10/2015

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