Provider Demographics
NPI:1780170084
Name:HARDEN, MARY ANNA (FNP)
Entity type:Individual
Prefix:
First Name:MARY ANNA
Middle Name:
Last Name:HARDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:3255 S ATLANTIC AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6279
Mailing Address - Country:US
Mailing Address - Phone:706-449-1658
Mailing Address - Fax:
Practice Address - Street 1:2215 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7017
Practice Address - Country:US
Practice Address - Phone:941-761-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9303770363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner