Provider Demographics
NPI:1629765615
Name:HARDY, ANDREA M (HEALTHCARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:HARDY
Suffix:
Gender:F
Credentials:HEALTHCARE PROVIDER
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 173
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21071-0173
Mailing Address - Country:US
Mailing Address - Phone:410-320-8279
Mailing Address - Fax:
Practice Address - Street 1:16 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1772
Practice Address - Country:US
Practice Address - Phone:410-320-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01355364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health