Provider Demographics
NPI:1760021414
Name:HARDY, LISA JUNE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JUNE
Last Name:HARDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LOG CABIN RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-2404
Mailing Address - Country:US
Mailing Address - Phone:478-230-7661
Mailing Address - Fax:
Practice Address - Street 1:113 LOG CABIN RD
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-2404
Practice Address - Country:US
Practice Address - Phone:478-230-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily