Provider Demographics
NPI:1326483017
Name:HARTLEY, AMY MELINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MELINDA
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MELINDA
Other - Last Name:HARTLEY-JESSEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 44230
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4230
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:8355 MERCHANTS GATE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5848
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7419
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical