Basic Information
| Provider Information | |||||||||
| NPI: | 1598057630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDIN | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11505 PALMBRUSH TRL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342022915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417472090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11505 PALMBRUSH TRL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342022915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417472090 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 03/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9105991 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 5601006002 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.