Provider Demographics
NPI:1558717595
Name:SHIRLEY HARTMAN, MD, PA
Entity Type:Organization
Organization Name:SHIRLEY HARTMAN, MD, PA
Other - Org Name:MANDARIN WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-268-5826
Mailing Address - Street 1:9283 SAN JOSE BLVD
Mailing Address - Street 2:B-2 S1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5584
Mailing Address - Country:US
Mailing Address - Phone:904-268-5826
Mailing Address - Fax:904-268-5873
Practice Address - Street 1:9283 SAN JOSE BLVD
Practice Address - Street 2:B-2 S1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5584
Practice Address - Country:US
Practice Address - Phone:904-268-5826
Practice Address - Fax:904-268-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care