Provider Demographics
NPI:1992084099
Name:HARTLEY, KERRIN D (ARNP)
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:D
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7948
Practice Address - Street 1:449621 US HIGHWAY 301
Practice Address - Street 2:SUITE 110
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-9348
Practice Address - Country:US
Practice Address - Phone:904-507-2692
Practice Address - Fax:904-507-2693
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9303001363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9303001OtherARNP LICENSE