Provider Demographics
NPI:1598057630
Name:HARDIN, WESLEY STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:STEPHEN
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11505 PALMBRUSH TRL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2915
Mailing Address - Country:US
Mailing Address - Phone:941-747-2090
Mailing Address - Fax:
Practice Address - Street 1:11505 PALMBRUSH TRL
Practice Address - Street 2:SUITE 220
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2915
Practice Address - Country:US
Practice Address - Phone:941-747-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105991363A00000X
MI5601006002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant