Provider Demographics
NPI:1386268910
Name:HARTMAN, MYKAILA CORRINE (NP)
Entity type:Individual
Prefix:
First Name:MYKAILA
Middle Name:CORRINE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8033
Mailing Address - Country:US
Mailing Address - Phone:480-688-6493
Mailing Address - Fax:
Practice Address - Street 1:1655 E UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8170
Practice Address - Country:US
Practice Address - Phone:480-969-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241238363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health