Provider Demographics
NPI:1649762253
Name:HARDIN, ROBIN SULLIVAN (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:SULLIVAN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4039
Mailing Address - Country:US
Mailing Address - Phone:601-469-4861
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4039
Practice Address - Country:US
Practice Address - Phone:601-469-4861
Practice Address - Fax:601-469-1238
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS812434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner