Provider Demographics
NPI:1124133582
Name:HARTMAN, ANGELA SUE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:SUE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 FOX MILL RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9354
Mailing Address - Country:US
Mailing Address - Phone:260-492-1721
Mailing Address - Fax:
Practice Address - Street 1:3103 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4738
Practice Address - Country:US
Practice Address - Phone:260-373-9300
Practice Address - Fax:260-373-9301
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000291A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS66322Medicare UPIN