Basic Information
| Provider Information | |||||||||
| NPI: | 1558372748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHIEF EDDIE HOFFMAN HWY | ||||||||
| Address2: | |||||||||
| City: | BETHEL AK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075436000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 E DIXIE AVE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523235200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 160483 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA 9103961 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.