Skip Navigation

Provider Information for 1093280380

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MR. KEVIN HARTZOG JR. ARNP

Gender: MALE

Individual NPI: 1093280380

Calendar   Last Updated:  2018-10-12
  Certification Date: 

Details

Name Value
NPI 1093280380
Enumeration Date 2018-10-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 401 W KENNEDY BLVD
TAMPA, FL 33606-1450
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 401 W KENNEDY BLVD
TAMPA, FL 33606-1450
United States

Phone: 727-215-3850 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL 9374252