Provider Demographics
NPI:1780683433
Name:HARTLEY, JOHN C (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 SICILIAN CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7016
Mailing Address - Country:US
Mailing Address - Phone:972-948-0698
Mailing Address - Fax:972-312-8765
Practice Address - Street 1:5916 SICILIAN CIR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7016
Practice Address - Country:US
Practice Address - Phone:972-948-0698
Practice Address - Fax:972-312-8765
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149479101Medicaid
TX83589HMedicare ID - Type Unspecified00C17N
TXP48861Medicare UPIN
TXTXB130554Medicare PIN