Provider Demographics
NPI:1760581268
Name:HARTLE, JENNIFER A (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:HARTLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:CCMC, POB II, SUITE 324
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-876-0347
Mailing Address - Fax:610-876-3788
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:CCMC, POB II, SUITE 324
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-876-0347
Practice Address - Fax:610-876-3788
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant