Provider Demographics
NPI:1134923659
Name:HARDISTY, TAYLOR LYNN (APRN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:HARDISTY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3010
Mailing Address - Country:US
Mailing Address - Phone:772-486-2493
Mailing Address - Fax:
Practice Address - Street 1:4601 MILITARY TRL STE 208
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4837
Practice Address - Country:US
Practice Address - Phone:561-795-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9440813163W00000X
FLAPRN11038614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse