Provider Demographics
NPI:1912499211
Name:HART, AMY JEANETTE (ANP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEANETTE
Last Name:HART
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEANETTE
Other - Last Name:BREAKFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST STE T100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4674
Mailing Address - Country:US
Mailing Address - Phone:907-561-3211
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER ST STE T100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4674
Practice Address - Country:US
Practice Address - Phone:907-561-3211
Practice Address - Fax:907-771-6991
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK132421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty