MEDICARE: MIRLINE HARDY CANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5259898	FL

General Provider Information

NPI Number	:	1194672394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRLINE HARDY CANN

Provider Business Mailing Address
First Line	:	657 NE LAGOON LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1226
Country	:	US
Telephone Number	:	718-828-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	657 NE LAGOON LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1226
Country	:	US
Telephone Number	:	718-828-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ MIRLINE HARDY CANN ” Practice Location

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