Provider Demographics
NPI:1194722751
Name:HARTLE, GERALD A JR (CRNP)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:HARTLE
Suffix:JR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20440 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-779-2273
Mailing Address - Fax:724-779-3006
Practice Address - Street 1:20440 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-0000
Practice Address - Country:US
Practice Address - Phone:724-779-2273
Practice Address - Fax:724-779-3006
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP0005684B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS76580Medicare UPIN
PA025749Medicare ID - Type Unspecified