Provider Demographics
NPI:1497212120
Name:HARTLEY, VANESSA ELIZABETH (APRN)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:ELIZABETH
Last Name:HARTLEY
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:PO BOX 198560
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8560
Mailing Address - Country:US
Mailing Address - Phone:801-771-7717
Mailing Address - Fax:866-506-1474
Practice Address - Street 1:1600 SNOW CREEK DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7372
Practice Address - Country:US
Practice Address - Phone:435-655-0055
Practice Address - Fax:435-655-8979
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7544993-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1578859831Medicaid