MEDICARE: MARIAH PAIGE HARDY APRN

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	363L00000X	Nurse Practitioner	11037565	FL

General Provider Information

NPI Number	:	1467267153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH PAIGE HARDY APRN

Provider Business Mailing Address
First Line	:	3555 GRANT RD
Second Line	:
City	:	GRANT
State	:	FL
Zip	:	32949-8204
Country	:	US
Telephone Number	:	321-536-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 CENTRE LAKE DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1113
Country	:	US
Telephone Number	:	321-821-4950
Fax Number	:

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

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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