Provider Demographics
NPI:1508351834
Name:HARTMAN, JARED LEE (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LEE
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 74 SENN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-0001
Mailing Address - Country:US
Mailing Address - Phone:760-540-1617
Mailing Address - Fax:
Practice Address - Street 1:BLDG 74 SENN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-2575
Practice Address - Country:US
Practice Address - Phone:760-540-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000927367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered