Provider Demographics
NPI:1699052563
Name:HARDGROVE, TERI LYNN (MSN)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:HARDGROVE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1510
Mailing Address - Country:US
Mailing Address - Phone:267-488-8701
Mailing Address - Fax:267-390-0030
Practice Address - Street 1:85 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1510
Practice Address - Country:US
Practice Address - Phone:267-488-8701
Practice Address - Fax:267-390-0030
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health