Provider Demographics
NPI:1144703257
Name:HART, ANNIE CELESTE (PA)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:CELESTE
Last Name:HART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W SERENO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7251
Mailing Address - Country:US
Mailing Address - Phone:480-776-4640
Mailing Address - Fax:
Practice Address - Street 1:3960 E RIGGS RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5411
Practice Address - Country:US
Practice Address - Phone:480-786-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant