Provider Demographics
NPI:1457463093
Name:HARDY, TRACY DARLENE (MS ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DARLENE
Last Name:HARDY
Suffix:
Gender:F
Credentials:MS ARNP
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 434
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-0434
Mailing Address - Country:US
Mailing Address - Phone:603-635-2802
Mailing Address - Fax:603-635-3070
Practice Address - Street 1:49 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3719
Practice Address - Country:US
Practice Address - Phone:603-635-2802
Practice Address - Fax:603-635-3070
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044030-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH044030-23-03OtherLICENSE NUMBER FOR NH
NH044030-23-03OtherLICENSE NUMBER FOR NH
HA NP4960Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER