Provider Demographics
NPI:1972014520
Name:HARDY, JENNIFER L (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HARDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 SE 72ND TER
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6334
Mailing Address - Country:US
Mailing Address - Phone:352-552-5078
Mailing Address - Fax:
Practice Address - Street 1:2845 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0444
Practice Address - Country:US
Practice Address - Phone:352-369-5300
Practice Address - Fax:352-369-5309
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-22
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9309077163WA2000X
FLARNP9309077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator