Provider Demographics
NPI:1043718356
Name:HARDRICK, IDALETT
Entity Type:Individual
Prefix:
First Name:IDALETT
Middle Name:
Last Name:HARDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7101
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-7101
Mailing Address - Country:US
Mailing Address - Phone:813-521-3759
Mailing Address - Fax:
Practice Address - Street 1:135 N 6TH ST FL 1
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4247
Practice Address - Country:US
Practice Address - Phone:813-521-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker