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NPI Code Detail

MEDICARE: ALEX BLAKE HARDY

MEDICARE: ALEX BLAKE HARDY
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
1363LP0222XCritical Care Pediatric Nurse Practitioner11035568FL

General Provider Information

NPI Number : 1912556465
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEX BLAKE HARDY
Provider Business Mailing Address
First Line : 10140 CENTURION PKWY N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-0532
Country : US
Telephone Number : 904-697-4199
Fax Number :
Provider Business Practice Location Address
First Line : 807 CHILDRENS WAY
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8426
Country : US
Telephone Number : 904-697-3600
Fax Number : 904-687-3927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2019
Last Update Date : 05/14/2026

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