Provider Demographics
NPI:1285600957
Name:HARTIN, JOHN E (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:HARTIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-2820
Mailing Address - Country:US
Mailing Address - Phone:806-349-9124
Mailing Address - Fax:806-349-9379
Practice Address - Street 1:540 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045
Practice Address - Country:US
Practice Address - Phone:806-364-2141
Practice Address - Fax:806-349-9379
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8495Medicare ID - Type Unspecified