Provider Demographics
NPI:1982838421
Name:HART, EMILY K (LAC, AP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:HART
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 TOWN PLAZA AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5175
Mailing Address - Country:US
Mailing Address - Phone:904-465-5571
Mailing Address - Fax:904-368-6020
Practice Address - Street 1:360 TOWN PLAZA AVE STE 330
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5175
Practice Address - Country:US
Practice Address - Phone:904-465-5571
Practice Address - Fax:904-368-6020
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
FLAP3840171100000X
CACA 10229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist