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NPI Code Detail

MEDICARE: VALERIE LYNN HATHAWAY ARNP

MEDICARE: VALERIE LYNN HATHAWAY 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
1363LF0000XFamily Nurse Practitioner1096022FL

Other Identifiers

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

General Provider Information

NPI Number : 1376545608
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE LYNN HATHAWAY ARNP
Provider Business Mailing Address
First Line : 3014 TAMIAMI TRL
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33952-4358
Country : US
Telephone Number : 941-625-7775
Fax Number : 941-625-2226
Provider Business Practice Location Address
First Line : 5952 CLARK CENTER AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2715
Country : US
Telephone Number : 941-924-9955
Fax Number : 941-924-5165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 08/22/2019

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