Provider Demographics
NPI:1265302764
Name:HARTANTO, DAVIN (PA)
Entity type:Individual
Prefix:
First Name:DAVIN
Middle Name:
Last Name:HARTANTO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:888-683-2778
Mailing Address - Fax:
Practice Address - Street 1:DESMOND T. DOSS HEALTH CLINIC
Practice Address - Street 2:BLDG 683
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:888-683-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant