Individual
COLLEEN LUCIA HARTSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
104 STUART RD NE, CLEVELAND, TN 37312-4803
(423) 476-2464
(423) 476-1008
Mailing address
PO BOX 2153 DEPT 40339, BIRMINGHAM, AL 35287-9387
(706) 271-0100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0956
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4051092
—
TN
Enumeration date
07/14/2006
Last updated
08/21/2020
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