MEDICARE: MARISSA MARIE HARTMAN FNP

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	205508	LA

General Provider Information

NPI Number	:	1619861721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MARIE HARTMAN FNP

Provider Business Mailing Address
First Line	:	126 DILLON DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4239
Country	:	US
Telephone Number	:	504-919-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1389 LAKEWOOD DR STE B
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-3127
Country	:	US
Telephone Number	:	504-919-3850
Fax Number	:

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

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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