Provider Demographics
NPI:1063898906
Name:HART, KATHRYN A (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:HART
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 PINE RIDGE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2110
Mailing Address - Country:US
Mailing Address - Phone:239-734-3481
Mailing Address - Fax:239-236-7982
Practice Address - Street 1:1575 PINE RIDGE RD STE 16
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2110
Practice Address - Country:US
Practice Address - Phone:239-734-3481
Practice Address - Fax:239-236-7982
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.399143163W00000X
FLRN9413497163W00000X
OHAPRN.CNP.023984363LP0808X
FLAPRN9413497363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015425900Medicaid
FLIG188ZMedicare PIN