Healthcare Provider Details

I. General information

NPI: 1780170084
Provider Name (Legal Business Name): MARY ANNA HARDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA HARDEN FNP

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 59TH ST W
BRADENTON FL
34209-7017
US

IV. Provider business mailing address

3255 S ATLANTIC AVE APT 707
DAYTONA BEACH SHORES FL
32118-6279
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-4994
  • Fax:
Mailing address:
  • Phone: 706-449-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9303770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: