Provider Demographics
NPI:1194074179
Name:HARDING, BRENDA (FNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W COMBS RD
Mailing Address - Street 2:SUITE 101-196
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-9105
Mailing Address - Country:US
Mailing Address - Phone:480-306-5650
Mailing Address - Fax:480-986-4300
Practice Address - Street 1:22717 S ELLSWORTH RD
Practice Address - Street 2:SUITE B101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6127
Practice Address - Country:US
Practice Address - Phone:480-306-5650
Practice Address - Fax:480-986-4300
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4673363LF0000X
AZAP4673363LF0000X
AZRN159911364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ169998Medicare PIN