Provider Demographics
NPI:1225700909
Name:HART, PAMELA M (APRN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 BLUE GRASS BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8067
Mailing Address - Country:US
Mailing Address - Phone:352-474-3420
Mailing Address - Fax:
Practice Address - Street 1:1612 BLUE GRASS BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-8067
Practice Address - Country:US
Practice Address - Phone:352-474-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily