Provider Demographics
NPI:1215399597
Name:HARDING, MATTHEW GILBERT (FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GILBERT
Last Name:HARDING
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18140 W NORTH CT
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4255
Mailing Address - Country:US
Mailing Address - Phone:574-780-1473
Mailing Address - Fax:
Practice Address - Street 1:12133 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9409
Practice Address - Country:US
Practice Address - Phone:623-244-8797
Practice Address - Fax:520-423-3929
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219166363LF0000X
IN71006126A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily