Provider Demographics
NPI:1073183240
Name:HARDT, MEREDITH ANGELEE (AG ACNP-BC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANGELEE
Last Name:HARDT
Suffix:
Gender:F
Credentials:AG ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4709
Mailing Address - Country:US
Mailing Address - Phone:480-393-0575
Mailing Address - Fax:480-704-4019
Practice Address - Street 1:5555 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4709
Practice Address - Country:US
Practice Address - Phone:480-393-0575
Practice Address - Fax:480-704-4019
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN183631163W00000X
AZ262536363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse