Provider Demographics
NPI:1083048474
Name:HARDY, ANGELA RAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:HARDY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8518
Mailing Address - Country:US
Mailing Address - Phone:937-446-2425
Mailing Address - Fax:
Practice Address - Street 1:7594 PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8518
Practice Address - Country:US
Practice Address - Phone:937-446-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN242056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily