Provider Demographics
NPI:1942571997
Name:HART DIVERSIFIED RESOURCES, INC.
Entity type:Organization
Organization Name:HART DIVERSIFIED RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-848-8422
Mailing Address - Street 1:6746 E HAYNES LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-7616
Mailing Address - Country:US
Mailing Address - Phone:615-848-8422
Mailing Address - Fax:352-419-6250
Practice Address - Street 1:125 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2403
Practice Address - Country:US
Practice Address - Phone:615-848-8422
Practice Address - Fax:352-419-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9312614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty