Provider Demographics
NPI:1730341405
Name:ROBINSON, HARDY (LPN)
Entity type:Individual
Prefix:
First Name:HARDY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6920
Mailing Address - Country:US
Mailing Address - Phone:813-236-6490
Mailing Address - Fax:
Practice Address - Street 1:3209 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6920
Practice Address - Country:US
Practice Address - Phone:813-236-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690323196372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690323198Medicaid
FL690323196Medicaid