Provider Demographics
NPI:1619952132
Name:HART, LINDA R (RNFA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:HART
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12416 91ST ST
Mailing Address - Street 2:
Mailing Address - City:FELLSMERE
Mailing Address - State:FL
Mailing Address - Zip Code:32948-5521
Mailing Address - Country:US
Mailing Address - Phone:772-571-8657
Mailing Address - Fax:772-571-0971
Practice Address - Street 1:12416 91ST ST
Practice Address - Street 2:
Practice Address - City:FELLSMERE
Practice Address - State:FL
Practice Address - Zip Code:32948-5521
Practice Address - Country:US
Practice Address - Phone:772-571-8657
Practice Address - Fax:772-571-0971
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2930672163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311332900Medicaid
FLX1619OtherBCBS