Provider Demographics
NPI:1255492484
Name:HARDY-HIBBERT, MARJORIE
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:HARDY-HIBBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:ELAINE
Other - Last Name:HARDY-HIBBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:5111 NW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6320
Mailing Address - Country:US
Mailing Address - Phone:305-331-8096
Mailing Address - Fax:
Practice Address - Street 1:3015 N OCEAN BLVD STE C101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7300
Practice Address - Country:US
Practice Address - Phone:754-270-6322
Practice Address - Fax:754-270-6321
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2026252363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health