Provider Demographics
NPI:1568439495
Name:HART, AMY LUEBKE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LUEBKE
Last Name:HART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CAROL
Other - Last Name:LUEBKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP OB/GYN
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4472
Practice Address - Fax:904-244-8411
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2622302367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000903735BMedicaid
GA000903735CMedicaid
FL3401871-00Medicaid
FLE5556WMedicare PIN
FL420001335Medicare PIN
FLP32180Medicare UPIN
FLE5556ZMedicare PIN