MEDICARE: MRS. SANDRA KAY HARTLEY ARNP

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	363LF0000X	Family Nurse Practitioner	9220988	FL

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	:	1285169672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY HARTLEY ARNP

Provider Business Mailing Address
First Line	:	3450 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2411
Country	:	US
Telephone Number	:	727-789-8887
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2411
Country	:	US
Telephone Number	:	727-789-8887
Fax Number	:

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

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/24/2017

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