Provider Demographics
NPI:1376645465
Name:HARTNER, JUDITH A (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:HARTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3920 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2205
Mailing Address - Country:US
Mailing Address - Phone:239-332-9510
Mailing Address - Fax:239-332-9656
Practice Address - Street 1:3920 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-2205
Practice Address - Country:US
Practice Address - Phone:239-332-9510
Practice Address - Fax:239-332-9656
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPHC122083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372865000Medicaid