MEDICARE: JANE A HARTMAN

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	00273	IA

General Provider Information

NPI Number	:	1417293762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE A HARTMAN

Provider Business Mailing Address
First Line	:	890 A1A BEACH BLVD
Second Line	:	SUITE 3
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-6776
Country	:	US
Telephone Number	:	319-269-3824
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 A1A BEACH BLVD
Second Line	:	SUITE 3
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-6776
Country	:	US
Telephone Number	:	319-269-3824
Fax Number	:

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

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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