Provider Demographics
NPI:1295729887
Name:HARTMAN, JENNIFER B (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 DEL PRADO BLVD N STE 301
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2278
Mailing Address - Country:US
Mailing Address - Phone:239-768-2111
Mailing Address - Fax:239-482-4404
Practice Address - Street 1:632 DEL PRADO BLVD N STE 301
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2278
Practice Address - Country:US
Practice Address - Phone:239-768-2111
Practice Address - Fax:239-482-4404
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003287363L00000X
FLAPRN11026698363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner