Provider Demographics
NPI:1487058418
Name:HARTMAN, TIARE KALEINANI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TIARE
Middle Name:KALEINANI
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TIARE
Other - Middle Name:KALEINANI
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-326-5629
Mailing Address - Fax:
Practice Address - Street 1:64-1032 MAMALAHOA HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-333-5303
Practice Address - Fax:808-339-7425
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical