Provider Demographics
NPI:1093879207
Name:HARTMAN, IRA G (ANP)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:G
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4206
Mailing Address - Country:US
Mailing Address - Phone:615-797-9799
Mailing Address - Fax:615-372-3599
Practice Address - Street 1:111 USSERY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4530
Practice Address - Country:US
Practice Address - Phone:615-673-6737
Practice Address - Fax:800-474-4039
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012361363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health