Provider Demographics
NPI:1447842737
Name:HARTS, JOSEPHINE (NP)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:HARTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:VIDUYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:BETHEL ISLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94511-0786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:707-401-1617
Practice Address - Street 1:1120 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2225
Practice Address - Country:US
Practice Address - Phone:925-663-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016958363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily