Provider Demographics
NPI:1548200553
Name:HART, LAURA (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4039
Mailing Address - Country:US
Mailing Address - Phone:352-436-2471
Mailing Address - Fax:
Practice Address - Street 1:908 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4039
Practice Address - Country:US
Practice Address - Phone:352-436-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9312614363LF0000X
AL1-069535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648207Medicare PIN
TN3648206Medicare PIN
TNQ34010Medicare UPIN
TN4120800OtherBLUE CROSS
TNP00297299OtherMEDICARE RAILROAD
TN4136461OtherBLUE CROSS