Provider Demographics
NPI:1780776732
Name:HALL, HARRIET LIN (ARNP)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:LIN
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 21ST AVE W
Mailing Address - Street 2:STE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5642
Mailing Address - Country:US
Mailing Address - Phone:941-794-5432
Mailing Address - Fax:941-794-5682
Practice Address - Street 1:5601 21ST AVE W
Practice Address - Street 2:STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-794-5432
Practice Address - Fax:941-794-5682
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2967852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5859OtherMEDICARE GROUP
FLD54742Medicare UPIN
FLE7435ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #