MEDICARE: MARISA ROSE HARTNETT FNP-C

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	11037938	FL

General Provider Information

NPI Number	:	1366335192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA ROSE HARTNETT FNP-C

Provider Business Mailing Address
First Line	:	317 NORTON DR STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-6044
Country	:	US
Telephone Number	:	850-402-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 NORTON DR STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-6044
Country	:	US
Telephone Number	:	850-402-6215
Fax Number	:

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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