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General NPI Number Information
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NPI Number | 1467267153
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Entity Type | Individual
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Provider Name | MARIAH PAIGE HARDY APRN
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 490 CENTRE LAKE DR NE
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City | PALM BAY
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State | FL
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Zip | 32907-1113
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Country | US
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Telephone | 321-821-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 3555 GRANT RD
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City | GRANT
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State | FL
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Zip | 32949-8204
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Country | US
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Telephone | 321-536-2933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11037565
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License Number State | FL
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