Provider Demographics
NPI:1689607186
Name:HART, LINDA L (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:TAVARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-794-6400
Mailing Address - Fax:804-897-0910
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-794-6400
Practice Address - Fax:804-897-0910
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164432363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09462OtherGROUP PTAN
VAP24389Medicare UPIN