Provider Demographics
NPI:1225228901
Name:HARDY, JOLENE CLARK (MD)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:CLARK
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JOLENE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-3627
Mailing Address - Country:US
Mailing Address - Phone:520-750-7160
Mailing Address - Fax:520-886-1929
Practice Address - Street 1:1555 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5831
Practice Address - Country:US
Practice Address - Phone:520-321-9850
Practice Address - Fax:520-321-9005
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80870207X00000X
UT7621240-1205207X00000X
AZ40282207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ40282OtherSTATE LICENSE