Provider Demographics
NPI:1912724279
Name:HART, JACLYN M (FNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-9601
Practice Address - Street 1:1 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2585
Practice Address - Country:US
Practice Address - Phone:603-772-3600
Practice Address - Fax:603-772-3601
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH069010-23363LF0000X
MARN2287695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily