Provider Demographics
NPI:1407119423
Name:HART, REBECCA M (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:340 HODGSON CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1520
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:BLDG #5
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-6270
Practice Address - Fax:912-927-6254
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2014-02-27
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Provider Licenses
StateLicense IDTaxonomies
GARN198296363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126241AMedicaid
GA003126241AMedicaid