Provider Demographics
NPI:1720742984
Name:HARTMANN, MATTIAS THOMAS NORBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTIAS
Middle Name:THOMAS NORBERT
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2653 BRUCE B DOWNS BOULEVARD
Mailing Address - Street 2:SUITE 108A #1037
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9211
Mailing Address - Country:US
Mailing Address - Phone:919-410-7362
Mailing Address - Fax:
Practice Address - Street 1:26539 CASTLEVIEW WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4738
Practice Address - Country:US
Practice Address - Phone:919-410-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001011812363A00000X
FL9115203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty