Individual
CHARLENE THERESA HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 DAYTONA AVE, HOLLY HILL, FL 32117-3721
(386) 258-8291
(386) 258-8291
Mailing address
1 GOODALL AVE, DAYTONA BEACH, FL 32118-4617
(386) 258-5562
(386) 238-5678
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
ALF10338
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142002000
—
FL
Enumeration date
02/24/2014
Last updated
02/24/2014
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