Healthcare Provider Details

I. General information

NPI: 1639893399
Provider Name (Legal Business Name): KYLIE NICOLE HARDIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD STE 210
APOPKA FL
32703-9210
US

IV. Provider business mailing address

2100 OCOEE APOPKA RD STE 210
APOPKA FL
32703-9210
US

V. Phone/Fax

Practice location:
  • Phone: 407-609-7391
  • Fax:
Mailing address:
  • Phone: 407-609-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPA9116485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: