Individual
DARYL KEITH HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 312-3490
(321) 956-2542
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 312-3490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9116370
FL
363AM0700X
Medical Physician Assistant
Primary
PA9116370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118743900
—
FL
01
—
Q7657
MEDICARE HF
FL
Enumeration date
10/08/2010
Last updated
05/23/2025
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