Provider Demographics
NPI:1710864764
Name:GABBARD, HARTLEY (NP)
Entity type:Individual
Prefix:
First Name:HARTLEY
Middle Name:
Last Name:GABBARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1330 N COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5526
Mailing Address - Country:US
Mailing Address - Phone:260-447-8982
Mailing Address - Fax:260-447-4483
Practice Address - Street 1:1330 N COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5526
Practice Address - Country:US
Practice Address - Phone:260-447-8982
Practice Address - Fax:260-447-4483
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016977A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily