Provider Demographics
NPI:1366637852
Name:HART, CARL RICHARD (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RICHARD
Last Name:HART
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 GEMINI ST
Mailing Address - Street 2:STE 200-B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2705
Mailing Address - Country:US
Mailing Address - Phone:281-486-7900
Mailing Address - Fax:281-286-8110
Practice Address - Street 1:1045 GEMINI ST
Practice Address - Street 2:STE 200-B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2705
Practice Address - Country:US
Practice Address - Phone:281-486-7900
Practice Address - Fax:281-286-8110
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669825207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R518Medicare PIN
TX8K0085Medicare PIN
TXP00439316Medicare PIN
TXCG0510Medicare PIN
TX760010407OtherTIN
TX760010407OtherEIN