Provider Demographics
NPI:1184009714
Name:HARDY, TANGELA (NP)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HUGUENOT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4311
Mailing Address - Country:US
Mailing Address - Phone:804-955-4814
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-955-4814
Practice Address - Fax:804-213-9783
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner