Provider Demographics
NPI:1417594318
Name:HARTIGAN, JANE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:HARTIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 AVIATION BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1032
Mailing Address - Country:US
Mailing Address - Phone:707-703-2617
Mailing Address - Fax:
Practice Address - Street 1:416 AVIATION BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1032
Practice Address - Country:US
Practice Address - Phone:707-703-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57589363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical