Provider Demographics
NPI:1164714994
Name:HIATT, DARLENE AMANDA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:AMANDA
Last Name:HIATT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:DARLENE
Other - Middle Name:AMANDA
Other - Last Name:HIATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1387 ROBIN HOOD LN
Mailing Address - Street 2:APT 3
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5347
Mailing Address - Country:US
Mailing Address - Phone:727-301-8572
Mailing Address - Fax:
Practice Address - Street 1:8001 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4109
Practice Address - Country:US
Practice Address - Phone:727-577-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9265473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily