Provider Demographics
NPI:1740544626
Name:HARDY, CRAIG A (PA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:HARDY
Suffix:
Gender:M
Credentials:PA
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 1268
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-1268
Mailing Address - Country:US
Mailing Address - Phone:386-222-3932
Mailing Address - Fax:386-213-9981
Practice Address - Street 1:807 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3109
Practice Address - Country:US
Practice Address - Phone:386-222-3932
Practice Address - Fax:386-213-9981
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114804363AM0700X
MEPA1345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant