Provider Demographics
NPI:1508545161
Name:HARTNICK, MARINA (NP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:HARTNICK
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 1:90 WEST ST APT 10E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1067
Mailing Address - Country:US
Mailing Address - Phone:617-455-1383
Mailing Address - Fax:
Practice Address - Street 1:90 WEST ST APT 10E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1067
Practice Address - Country:US
Practice Address - Phone:617-455-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2359925363LA2200X
NY311648363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health