Provider Demographics
NPI:1497746804
Name:HARDEN, MARY LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:HARDEN
Suffix:
Gender:F
Credentials: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 7151
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7151
Mailing Address - Country:US
Mailing Address - Phone:239-939-3303
Mailing Address - Fax:239-939-7373
Practice Address - Street 1:4535 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2930
Practice Address - Country:US
Practice Address - Phone:941-629-9700
Practice Address - Fax:941-629-5800
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1269782363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6603VMedicare ID - Type Unspecified