Provider Demographics
NPI:1598504482
Name:HART, JANELLE
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-1043
Mailing Address - Country:US
Mailing Address - Phone:352-256-2473
Mailing Address - Fax:
Practice Address - Street 1:3249 W RAILROAD LN
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-5104
Practice Address - Country:US
Practice Address - Phone:352-256-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5202374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty