Provider Demographics
NPI:1194038547
Name:HART, STEFANIE ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ELIZABETH
Last Name:HART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 VAL MAR DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3140
Mailing Address - Country:US
Mailing Address - Phone:239-823-6353
Mailing Address - Fax:
Practice Address - Street 1:569 VAL MAR DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3140
Practice Address - Country:US
Practice Address - Phone:239-823-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor