Provider Demographics
NPI:1033757067
Name:HARDGROVE, JENNIFER T (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:T
Last Name:HARDGROVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-353-9494
Mailing Address - Fax:360-353-9440
Practice Address - Street 1:6450 SOUTHCENTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2552
Practice Address - Country:US
Practice Address - Phone:206-466-5410
Practice Address - Fax:206-721-1287
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP610225817363LP2300X
WAAP61025817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care