Provider Demographics
NPI:1447831953
Name:HARTT, JENNA MARIE (PA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:HARTT
Suffix:
Gender:
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3664 WILD SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-4728
Mailing Address - Country:US
Mailing Address - Phone:239-938-4610
Mailing Address - Fax:239-694-1571
Practice Address - Street 1:14071 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4330
Practice Address - Country:US
Practice Address - Phone:239-694-7546
Practice Address - Fax:239-694-1571
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant