Provider Demographics
NPI:1154329290
Name:HARDING, LONNIE RAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:RAY
Last Name:HARDING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 STATE ROAD 674
Mailing Address - Street 2:SUITE A
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-3530
Mailing Address - Country:US
Mailing Address - Phone:813-633-8489
Mailing Address - Fax:813-633-2669
Practice Address - Street 1:5129 STATE ROAD 674
Practice Address - Street 2:SUITE A
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-3530
Practice Address - Country:US
Practice Address - Phone:813-633-8489
Practice Address - Fax:813-633-2669
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2166363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-3923Medicare ID - Type UnspecifiedRURAL HEALTH CENTER