Provider Demographics
NPI:1598099723
Name:HART, AGDA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:AGDA
Middle Name:L
Last Name:HART
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1503 BUENOS AIRES BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6821
Mailing Address - Country:US
Mailing Address - Phone:352-750-5882
Mailing Address - Fax:888-770-3208
Practice Address - Street 1:1731 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8179
Practice Address - Country:US
Practice Address - Phone:352-369-0322
Practice Address - Fax:352-369-0325
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2012-07-12
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Provider Licenses
StateLicense IDTaxonomies
FL9103822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCP513ZMedicare Oscar/Certification