Doctor Name: | TARA DANIELLE HARTMAN |
NPI Number: | 1144617705 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0024172439 |
Business Practice Address: | 1040 Holston Rd Wytheville, VA - 243824107 |
Business Phone Number: | 2762270200 |
Business Fax Number: | |
Mailing Address: | 1040 Holston Rd, WYTHEVILLE |
State: | VA |
Postal Code: | 243824107 |
Phone Number: | 2762270200 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2015 |
NPI Last Update Date: | 04/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 0024172439 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |