Provider Demographics
NPI:1194168880
Name:HARTMAN, JOHN JACOB (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JACOB
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 S HYDE PARK AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2286
Mailing Address - Country:US
Mailing Address - Phone:813-258-4607
Mailing Address - Fax:813-258-4647
Practice Address - Street 1:300 S HYDE PARK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2286
Practice Address - Country:US
Practice Address - Phone:813-258-4607
Practice Address - Fax:813-258-4647
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5634103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis