Hartley, Charlene Theresa

Hartley, Charlene Theresa is an individual health care provider with primary practice located at 425 Daytona Ave , Holly Hill FL 32117-3721. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Hartley, Charlene Theresa can be contacted via phone (386) 258-8291.

Contact Information

Primary practice address
425 Daytona Ave Holly Hill FL 32117-3721
Fax: (386) 258-8291
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X ALF10338 Florida

Profile Details

NPI number 1649695974
LBN Legal business name Hartley, Charlene Theresa
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 24th, 2014
Last updated Feb 24th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649695974 NPPES
Florida MEDICAID 142002000

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