Provider Demographics
NPI:1598713869
Name:HARDTKE, JOANNE GIGI (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:GIGI
Last Name:HARDTKE
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 1:3702 S FIFE ST
Mailing Address - Street 2:SUITE K, PMB 402
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7374
Mailing Address - Country:US
Mailing Address - Phone:253-212-0093
Mailing Address - Fax:866-375-6026
Practice Address - Street 1:7424 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8120
Practice Address - Country:US
Practice Address - Phone:253-212-0093
Practice Address - Fax:866-375-6026
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9637612Medicaid
WA9637612Medicaid
WAP81794Medicare UPIN