Provider Demographics
NPI:1578365599
Name:HART, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:HART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 ROGERO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4008
Mailing Address - Country:US
Mailing Address - Phone:904-726-2105
Mailing Address - Fax:904-726-2105
Practice Address - Street 1:2334 ROGERO RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4008
Practice Address - Country:US
Practice Address - Phone:904-726-2105
Practice Address - Fax:904-726-2105
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service